Community Inclusion for Adults with Autism€¦ · Community Inclusion for Adults with Autism ......

2010

Community Inclusion for

Adults with Autism

Guidance for Providers in Pennsylvania

Eastern Region ASERT at Lehigh University and

Community Adult Autism Partnership Program at Devereux CARES

Community Inclusion Manual 2

This document was developed through the Eastern Region Autism Service,

Education, Research, and Training (ASERT) Center funded by a grant from the PA

Department of Public Welfare’s Bureau of Autism Services

For further information please contact:

Bureau of Autism Services

PA Dept of Public Welfare

P.O. Box 2675

Harrisburg, PA 17105

866-539-7689 Toll free

Contributors:

Eastern Region ASERT at Lehigh University

Clare Papay, M.Ed., Project Assistant

Linda Bambara, Ed.D., Co-Principal Investigator

Anastasia Kokina, M.Ed., Project Assistant

Catherine Kunsch, M.S., Project Coordinator

Erin McCurdy, M.Ed., Project Assistant

Christine Cole, Ph.D., Co-Principal Investigator

Devereux Pennsylvania

Betsy Swope, Ph.D., Director, Community Adult Autism Partnership Program

Todd Harris, Ph.D., Director, Division of Autism Services

Brandee El-Attar, M.S., Consultant, Devereux CARES


Acknowledgements

This manual is a result of the collaborative efforts of Devereux Pennsylvania and

Eastern Region ASERT at Lehigh University. In addition to numerous best practice

resources identified throughout the manual, many of the practices described have been

informed by the services and experiences provided by Lehigh University’s Transition

and Assessment Services and Devereux CARES (Childhood Autism Research and

Educational Services) and CAAPP (Community Adult Autism Partnership Program).

We gratefully acknowledge the many staff and individuals who were involved in

developing these practices.


Table of Contents

SECTION 1: OVERVIEW AND GUIDING PRINCIPLES .......................................................... 6 Introduction ............................................................................................................................. 6 Purpose and Target Audience ................................................................................................. 6 Guiding Principles .................................................................................................................. 6

Characteristics and Needs of Adults with ASD ...................................................................... 7 Organization of the Manual .................................................................................................... 8 Summary ................................................................................................................................. 9

SECTION 2: TYPES OF SERVICES .......................................................................................... 11 Introduction ........................................................................................................................... 11

Funding Sources in Pennsylvania ......................................................................................... 11 Service Types ........................................................................................................................ 11

Enrolling as a Provider.......................................................................................................... 13

Summary ............................................................................................................................... 14

SECTION 3: GETTING STARTED ............................................................................................ 15 Introduction ........................................................................................................................... 15 General Description .............................................................................................................. 15

How to Implement ................................................................................................................ 16 Case Study ............................................................................................................................ 19

Summary ............................................................................................................................... 19 SECTION 4: GENERAL PROCESS FOR PROVIDING SERVICES ........................................ 21

Introduction ........................................................................................................................... 21

General Description .............................................................................................................. 21 How to Implement ................................................................................................................ 21

Summary ............................................................................................................................... 26 SECTION 5: EMPLOYMENT SUPPORTS AND SERVICES .................................................. 27

Introduction ........................................................................................................................... 27 5.1 Finding employment ........................................................................................................... 27

General Description .............................................................................................................. 27

How to Implement ................................................................................................................ 30 Case Study ............................................................................................................................ 46

Checklist for Finding Employment ....................................................................................... 47 5.2 Supported employment ....................................................................................................... 48


How to Implement ................................................................................................................ 49 Case Study ............................................................................................................................ 53 Checklist for Supported Employment ................................................................................... 53

5.3 Preparing for competitive employment .............................................................................. 55

General Description .............................................................................................................. 55 How to Implement ................................................................................................................ 56 Case Study ............................................................................................................................ 59 Checklist for Preparing for Employment .............................................................................. 59 Summary ............................................................................................................................... 60

SECTION 6: COMMUNITY INCLUSION SUPPORTS AND SERVICES .............................. 61 Introduction ........................................................................................................................... 61



How to Implement ................................................................................................................ 62 Case Study ............................................................................................................................ 69 Checklist for Community Inclusion ...................................................................................... 69

Summary ............................................................................................................................... 71 SECTION 7: INSTRUCTIONAL STRATEGIES AND SUPPORTS ......................................... 72

Introduction ........................................................................................................................... 72 General Description .............................................................................................................. 72 How to Implement ................................................................................................................ 73

A. Situational Assessment ............................................................................................... 73 B. Instructional Strategies ............................................................................................... 77 C. Instructional Supports ................................................................................................. 92 Summary ............................................................................................................................. 106

SECTION 8: OPERATIONAL ISSUES .................................................................................... 108 Introduction ......................................................................................................................... 108

Summary ............................................................................................................................. 116 SECTION 9: PROGRAM EVALUATION ................................................................................ 117

Summary ............................................................................................................................. 125 References ................................................................................................................................... 127 APPENDIX A: FUNDING SOURCES ...................................................................................... 129

APPENDIX B: CHECKLISTS ................................................................................................... 134 APPENDIX C: FORMS ............................................................................................................. 143


SECTION 1: OVERVIEW AND GUIDING PRINCIPLES

Introduction

In this section we discuss the purpose and target audience for this manual. We provide

an explanation of the principles that have guided our approach to supporting

individuals with autism spectrum disorders (ASD) to be involved in their communities

and describe the characteristics and needs of individuals with ASD. Finally, we provide

an overview of the organization of this manual.

Purpose and Target Audience

The purpose of this manual is to offer guidance for providing supports for persons with

ASD to be involved in their communities and to work in inclusive settings. The manual

is designed to be used by providers of services to individuals with ASD who are eligible

and receiving services under the Adult Autism Waiver, Adult Community Autism

Program (ACAP), OBRA Waiver, Person/Family Directed Support (P/FDS) Waiver, or

Consolidated Waiver. It is designed to address the needs of a wide range of individuals

on the spectrum from individuals with significant support needs to individuals such as

those with Asperger Syndrome who may require less pervasive supports. This manual

does not address supports provided in facility-based work programs or segregated day

programs.

Families may also find the manual of interest when advocating for services or designing

supports for their children with service providers.

Guiding Principles

The recommendations for supports provision made in this manual are based are the

following ten guiding principles.

1. Supports and services are driven and guided by the individual and the family

The individual is the primary decision-maker in selecting the types of services, hours of service provision,

and specific aspects of supports provision. It should always be assumed that the individual knows what

is best for him or her. Families have an important role in helping to speak for the individual’s needs and

preferences.

2. Supports and services promote self-determination and self-advocacy

Individuals are encouraged and supported to make their own decisions and advocate for themselves in

community settings.


3. Supports and services are individualized

An individual is provided with a program that is based on an individual assessment of his or her

interests, strengths, and needs. A program is designed for each individual rather than fitting him or her

into an existing program.

4. Supports and services are provided to participate in every aspect of socio-cultural life

All aspects of socio-cultural life (including, but not limited to, home, school, work, cultural and spiritual

activities, leisure, travel and political life) should be considered when planning supports for community

inclusion.

5. Supports and services are based on a philosophy of acceptance

The goal of supports and services is not to “cure” a person of autism, but rather to capitalize on the

person’s unique strengths and address the person’s challenges in order to ensure community

participation and life satisfaction.

6. Supports and services are respectful and age-appropriate

Not only should the supports and services be appropriate for adults, but the manner in which supports

are provided should exemplify a relationship characterized by dignity and respect.

7. Supports and services are designed to promote the full inclusion of individuals in their

communities

The goal of services should be for individuals to become fully included in all aspects of their

communities. To the greatest extent possible, activities should be non-segregated.

8. Supports and services promote independence and foster interdependence on naturally occurring

supports in the individual’s environments

For individuals to become fully included in their communities, supports should become less artificial and

interdependence on typical persons in community settings should build.

9. Supports and services are culturally responsive

Services acknowledge the cultural heritage of the individuals being served and are planned to take into

account cultural preferences and experiences.

10. Supports and services are provided with integrity and quality

Quality of services and progress toward goals are continually evaluated and changes are made when

necessary. Periodic program evaluation is conducted to ensure all services are meeting the needs of

individuals and exemplify current best practices.

Characteristics and Needs of Adults with ASD

Autism is a pervasive developmental disorder characterized by difficulties in social

skills, communication, and behavior. Five disorders fall under the umbrella of Autism

Spectrum Disorders: autism, Asperger Syndrome, pervasive developmental disorder-


not otherwise specified (PDD-NOS), Rett syndrome, and childhood disintegrative

disorder (CDD). Individuals who fall on this spectrum have some common

characteristics that impact their inclusion in the community:

Social relationships: Individuals with ASD may experience difficulties relating to others

and forming friendships. They may have difficulties in areas such as understanding the

feelings of others, understanding nonverbal communication, and interacting with

others. These challenges can impede inclusion in work and community settings where

individuals with ASD may have trouble interacting and forming relationships with

coworkers and potential friends.

Communication: In addition to difficulties in social skills, individuals with ASD may

experience difficulties in communication. These difficulties may include the lack of

ability to initiate or sustain a conversation, repeating words or phrases (echolalia),

trouble understanding both verbal and nonverbal communication, or not using words

to communicate at all. These challenges can inhibit interaction with coworkers and

others in community settings as these people may not understand the attempts to

communicate made by the individual with ASD.

Behavioral issues: Finally, individuals with ASD may exhibit certain behavioral

characteristics such as insistence on sameness or predictability, repetitive or

stereotypical motor movements, and highly specialized interests. Some individuals may

develop behaviors that are highly challenging and limit inclusion in community

settings. However, not all of these behaviors should be viewed as undesirable as many

can be capitalized upon to create good matches between the individual and work or

other community activities.

Despite these common characteristics which define ASD, each person must be viewed

individually in terms of his or her own strengths and support needs. Furthermore,

despite personal limitations and challenges, all individuals can be supported and

provided with instruction that enables them to be fully included in their communities

with careful planning and intervention. This manual merges best practices for

community inclusion relevant for all individuals with developmental disabilities with

specific support strategies that address the unique characteristics of adults with ASD.

Organization of the Manual

The manual is organized into nine sections


In section one, you will find an overview of the manual and the guiding

principles

In section two, we provide an overview of the types of services that can be

provided for adults with ASD and the funding sources that can be used for each

service.

In section three, you will find a process for determining what services a person

needs when they first approach your agency.

In section four, we provide a general process for providing community inclusion

services that is explained further in section five and six.

Sections five and six provide guidance for employment and community

inclusion services. In each of these sections you will find a general description of

the service, steps to follow in providing these services, case studies, and a

checklist to ensure that your services continue to adhere to the guiding

principles.

In section seven, we provide guidance on specific instructional procedures and

support strategies that you will use in providing services to adults with ASD.

In section eight, you will find information on operational issues such as staffing,

training, and billing.

Finally, in section nine, we provide guidance on evaluating your overall

program.

In sections three, five, and six, we illustrate the services discussed with real-life case

studies of persons served by the Devereux CARES Community Adult Autism

Partnership Program (CAAPP). In these case studies, a majority of details are true but

names have been changed.

Additionally, in the appendices you will find:

Appendix A: a description of four funding sources for community inclusion

services for adults with ASD.

Appendix B: checklists for ensuring that your services adhere to the guiding

principles of this manual.

Appendix C: blank copies of forms that are described in this manual.

Summary

In this section we described the purpose, target audience, and guiding principles for

this manual. We discussed some characteristics of ASD and provided an overview of

the organization of the manual. In the next section we give an overview of the types of


community inclusion services that can be provided through funding sources in

Pennsylvania.


SECTION 2: TYPES OF SERVICES

Introduction

In this section we describe the types of community inclusion services that can be

provided currently through each funding source in Pennsylvania.

Funding Sources in Pennsylvania

In Pennsylvania, the four primary sources of Medicaid funding for services for adults

with ASD are:

Adult Autism Waiver (Department of Public Welfare, Bureau of Autism

Services)

Adult Community Autism Program (ACAP, Department of Public Welfare,

Bureau of Autism Services)

Person/Family Directed Support (P/FDS) and Consolidated Waivers (Department

of Public Welfare, Office of Developmental Programs)

OBRA Waiver (Department of Public Welfare) (Note that at the time of writing

this manual, this waiver was no longer accepting new applications).

A table comparing eligibility and services offered can be found in the appendix. Note

that at the time of preparing this manual, the ACAP was only available in four counties

in PA with the promise of expansion to other counties in the near future. For further

eligibility information for each of these funding sources, see the DPW website:

www.dpw.state.pa.us.

Service Types

Under each of these funding sources, services can be provided for supported

employment and community inclusion. As the names given to these services vary

under each funding source, we explain how typical goals for each type of service map

to the service names for each source of funding.

Employment services include supports for preparing for employment, finding

employment, and maintaining employment. A summary of typical goals for

employment services and the service names for employment services under each

funding source is provided in the table below.

http://www.dpw.state.pa.us/


Type of

service

Typical goal Service Name by Funding

Autism

Waiver

ACAP P/FDS/

Consolidated

OBRA

Preparing for

employment

<will learn

skills and

work habits

and gain

experiences

necessary for

competitive

employment

Transitional

work

services

Pre-

vocational

services

Transitional

work services

Finding

employment

<.will find

paid

employment

Job

assessment

Job finding

Supported

employment

Supported

employment

Supported

employment

Supported

employment

<will

maintain paid

employment

Supported

employment

Supported

employment

Supported

employment

Supported

employment

Community inclusion services are supports for persons to access and be integrated into

community settings such as postsecondary education, volunteer activities, leisure and

recreation activities, socialization activities, exercising civic rights and responsibilities,

typical community services available to all people, and other activities of daily living. A

summary of the goals for community inclusion services and the service definitions for

community inclusion services under each funding source is provided in the table below.

Type of

service

Typical

goal

Service Name by Funding

Autism

Waiver

ACAP P/FDS/

Consolidated

OBRA

Community

inclusion

<will

access

community

settings/

build

network of

community

supports

Community

inclusion

Adult day

habilitation

Unlicensed

Home and

community

habilitation

Community

integration

Under all these sources of funding, employment and community inclusion services

cannot be provided at the same time (concurrently), but a person may be provided with

a combination of each type (e.g., 25 hours supported employment and 6 hours


community inclusion per week). There may be additional limitations on the number of

hours a person can receive each service based on the type of waiver and other services

they are receiving OR limitations on the length of time for which a particular service can

be received. For all types of services you should refer to the requirements for each

waiver (see waiver service definitions and consult with supports coordinators for

further guidance).

Enrolling as a Provider

A table explaining the procedures for enrolling as a provider of services through each of

the funding sources can be found in the Appendix: Funding Sources. Some funding

sources require providers to undergo specific training. For example, to become a

provider through the Autism Waiver, at least one staff person must complete the

SPeCTRUM: Supporting Persons Centered Training, Resources, Understanding and

Mentorship training through the Bureau of Autism Services. More information on

enrolling as a provider can be found on the websites listed below.

Resources:

Autism Waiver:

Information and service definitions are available through DPW:

http://www.dpw.state.pa.us/ServicesPrograms/Autism/003677257.htm

ACAP:

Information is available through DPW and the Bureau of Autism Services:


OBRA Waiver:

Service definitions are available at:

http://www.dpw.state.pa.us/Resources/Documents/Pdf/FillInForms/Waiver/2006-

2011OBRA.pdf

P/FDS and Consolidated Waivers:

Information and service definitions are available from The Pennsylvania Training

Partnership for People with Disabilities and Families

http://www.temple.edu/thetrainingpartnership/resources/waiver/

Devereux’s Transition Wiki:

http://autismtransitionwiki.com/index.php/Main_Page



http://www.dpw.state.pa.us/Resources/Documents/Pdf/FillInForms/Waiver/2006-2011OBRA.pdf

http://www.dpw.state.pa.us/Resources/Documents/Pdf/FillInForms/Waiver/2006-2011OBRA.pdf

http://www.temple.edu/thetrainingpartnership/resources/waiver/

http://autismtransitionwiki.com/index.php/Main_Page


Summary

In this section we discussed the types of services that can be provided under each

funding source in Pennsylvania and referred the reader to the appendix for more

information on eligibility for consumers and providers. In the following section we

describe a process for determining what services an individual can be provided with.


SECTION 3: GETTING STARTED

Introduction

In this section we describe a process that can be followed for determining what services

an individual needs when he or she first approaches your agency. This process involves

person-centered planning and results in recommendations for service types, a weekly

schedule, and general goals for community inclusion.

General Description

When a person approaches your agency for community inclusion supports and

services, you will first need to figure out what services he or she needs. Although this

may already be specified in the person’s Individual Support Plan (ISP), we recommend

that you take time to follow the process described here to improve your understanding

of the individual and the services that he or she needs from your agency. This process

involves meeting with the person, his or her family, and the supports coordinator in

order to determine the types of services and the number of service hours the person

needs. The process of determining the types of services a person needs will be

completely individualized: some people may have a clear understanding of the types of

services they are looking for and may have already agreed with their supports

coordinators on the number of hours they will need; others may just be beginning to

explore adult services and may not yet know the specific type and amount of services

they are looking for. In all cases, we recommend that you follow this process:


How to Implement

Step 1: Begin with an initial interview.

First, determine whether the person knows what services he or she is looking for or

whether further exploration is required. The following example from the Community

Adult Autism Partnership Program at Devereux Cares shows the type of questions that

should be asked in an initial interview with the person and his or her family:

What do you like to do?

What skills do you have?

What experiences have you had? (e.g., employment, volunteer, training, personal

development)

What are your goals in relation to employment and community involvement?

How would you like to achieve those goals? How can we help you get there?

What services do you need?

What supports do you need or want?

What financial and non-monetary benefits do you need or want? (e.g., wages,

health insurance, other benefits)

What experiences have you had that make it difficult for you to work or access

the community?

What is your ideal routine?

Step 1: Begin with an initial interview to determine whether the person knows what services he or she needs or whether further exploration is required.

Step 2: If necessary, engage in person-centered planning by meeting with the person and his or her family and friends to create a vision for the person's likes, interests, and the services and supports that will be required.

Step 3: Agree on the services that will be provided, generate a weekly schedule, and develop goals.


You should also explain the types of services and supports your agency can provide

and begin to determine whether you can provide what the person is looking for. If the

person has a clear idea of the services and supports that he or she needs and you agree

that your agency can provide these services, move to step 3. If further exploration is

needed to determine what services the person needs, proceed to step 2.

Step 2: Engage in person-centered planning.

Person-centered planning is a process through which the individual develops a vision

for his or her future and a plan to achieve his or her dream. The individual is assisted in

this process by important people in his or her life, such as family members, friends, and

community members. Although there are a number of approaches to person-centered

planning and several excellent published guides that you can choose to help you (see

resources at the end of this section), person-centered planning generally is conducted

through a meeting in which several key questions are asked. In addition to these key

questions, you may choose to review relevant data from standardized or other

assessments (e.g., Scales of Independent Behavior-Revised, or the Supports Intensity

Scale) to get a better understanding of the strengths and needs of the individual.

The meeting should take place either at the person’s house or another location in which

he or she feels comfortable. The individual and his or her family should determine who

to invite to the meeting. Planning team members can include family, friends,

community members, professionals, or any other person who is important in the

individual’s life. The meeting can be led by an outside facilitator or by one of the

planning team members, depending on the preferences of the individual and the team.

At the person-centered planning meeting, several key questions need to be considered.

These include:

Who is [the individual]?

o What is his or her story?

o What are his or her strengths?

o What are his or her limitations?

o What are his or her interests and preferences?

What is the individual’s dream for his or her future?

o What type of employment is the individual seeking?

o What type of living situation does the individual desire?

o How does the individual want to be involved in the community?

o What kinds of leisure and recreation activities are important to the

individual or would he or she like to try?


o How will the individual build and maintain personal relationships?

What will the person need to achieve his or her dreams?

What obstacles may need to be overcome to achieve his or her dreams?

The meeting will probably take at least 2 hours, sometimes more if the individual has

significant support needs. At the end of the meeting, the planning team members

should develop a plan of action for assisting the individual in achieving his or her

dreams. Following the meeting, a document should be created that summarizes the

answers to these questions so that this information can guide planning for community

inclusion and other services.

Step 3: Agree on services, generate a weekly schedule, and develop goals.

Once you have a clear understanding of the individual’s dream for his or her future,

you should determine what services you will provide. To do this, you will need to work

together with the person and his or her supports coordinator to determine the

configuration of services (employment and community inclusion services) that best fits

the individual’s needs. After determining the number of hours that each service will be

provided each week, you should create a general weekly schedule that specifies the

hours of each service. This schedule should be developed through collaboration with

the individual, his or her family or other support staff, and the supports coordinator to

determine the optimal times for supports provision. For example, supported

employment services will be provided 5 days per week, Monday-Friday 9am-2pm, and

community inclusion services will be provided Monday, Wednesday, and Friday 2-

6pm. The supports coordinator can assist in connecting the individual with additional

services for which the individual may need (e.g., behavioral supports) or for which the

individual may be eligible (e.g., transit passes, computers).

Finally, you should consider the general goals that the individual will work towards

with the help of your services. For example,

Jane will learn appropriate work skills and behaviors

Derek will seek paid employment in an office setting

Jay will take a class at the community college

A more detailed schedule and specific goals with measurable objectives will be

developed once services begin (see Section 4).


Case Study

“Tommy’s mother called the CAAPP at Devereux CARES a few weeks after her son had

graduated high school upon realizing that he didn’t have a program to enter. He was

currently living at home with her, and although he wanted to go out into his

community, he currently didn’t have a job and rarely was able to enjoy other events in

the community. When we met with the family, we were sure to clearly understand and

ask what both Tommy and his mother’s preferences were for an ideal day and schedule

for Tommy. We utilized our Person-Centered Planning interview questions and

discussion starters.

Through our discussions we learned that Tommy really enjoyed riding the bus, but only

knew limited routes. He also desired to be in better shape and enjoyed cooking, but

had limited skills in that area. Tommy’s supports coordinator was very valuable to the

process to help determine necessary and available services. By using our basic skills

checklist (this tool utilizes observations and interview to rate skill abilities) and taking

into account the preferences of the family and individual, we were able to help develop

a plan for Tommy. This plan included joining a local gym, learning additional bus

routes, practicing grocery shopping, and obtaining a job in a kitchen. A schedule was

proposed by the team and altered based on family needs, and goals were assigned for

completion for each day. Now Tommy is able to access to the community and his job

five days a week – he has lost weight, made friends, and his family reports that his

quality of life has increased.”

Summary

In this section we described the initial person-centered planning process that should be

followed to determine what services, hours, and goals an individual requires. In the

following section we provide an explanation of the general process for providing

community inclusion services and supports.

Forms (see Appendix: Forms):

Devereux’s application form as an example

Devereux’s future planning form for annual meetings

Resources:

1. MAPS (Making Action Plans), PATH, and Circles of Friends


For books on these methods, see the Inclusion Press website:

http://www.inclusion.com/inclusionpress.html

2. Personal Futures Planning

See: Mount, B. (2000). Life building: Opening windows for change using personal future

planning. New York, NY: Graphic Futures, Inc.

http://www.inclusion.com/inclusionpress.html


SECTION 4: GENERAL PROCESS FOR PROVIDING SERVICES

Introduction

In this section we describe the general process that should be followed for developing

and implementing community support services. The steps of assessing, planning,

providing, and evaluating services will be followed regardless of the types of services

that an individual is receiving. In sections 5 and 6, we describe how this process is used

specifically for providing employment and community inclusion services.

General Description

Regardless of the type or amount of services that are to be provided to a person, we

advocate the following overarching process for developing and implementing

community support services:

How to Implement

Assess: Get to know the person and the specific supports and services he or she needs

Assess: Get to know the person and the supports and services he or she needs

Plan: Determine needed experiences and goals to be worked on and develop a weekly schedule

Provide: Provide supports and services in a manner that is consistent with the guiding principles

Evaluate: Examine instructional and other data to determine if supports are assisting the individual to progress towards his or her goals and make changes

if needed


Successful services are based on a good understanding of the individual’s strengths,

preferences, interests, and needs. When beginning services, you should take time to get

to know the person. The amount of time this will take will depend on the individual.

The information you will need can be gathered through a number of methods

including:

Spending time with the individual

Interviewing the individual and his or her family, friends, and previous teachers

or support workers

Reviewing past records

Implementing a preference assessment

Once you have a good understanding of the individual, you will need to determine the

skills that you will target for instruction and the other supports that will be needed to

increase participation in community activities. This can be achieved by conducting

situational assessments in the settings in which you will be providing supports to the

individual. Situational assessments involve actual observations of the individual in the

target setting and are used to determine both the skills that will require instruction and

the other supports that the individual will need. More information on conducting

situational assessments can be found in Section 7.

At the end of this assessment period you should have a clear understanding of the

strengths, preferences, and interests of the individual and the instruction and other

supports the individual needs. You may want to summarize the results of this

assessment period in an assessment report.

Plan: Determine needed experiences and goals to be worked on and develop a weekly schedule

Once you have a clear understanding of the individual’s interests, preferences, and

needs, the next step is to determine a) the goals that the person will work towards and

the experiences they will be provided with through your services and supports, and b)

the activities through which you will assist the individual to work on his or her goals

and gain necessary experiences.

Several important considerations need to be made when selecting appropriate

instructional goals. Specifically, the targeted goals should be:

Meaningful

Functional

Age-appropriate


Meaningful goals are those that should help the individual to achieve critical life goals

such as establishing friendships, communication, independence, access to job or

community, and quality of life. An important factor when selecting meaningful goals

should be the individual’s choices, preferences, and interests. Consider Peter, a young

adult with ASD, who has a keen interest in the exploration of bird species and would

like to attend an undergraduate course and a corresponding workshop on the topic in

the Biology department of a local university. Attending the college course would be a

meaningful goal for this individual. In contrast, assigning Peter an office job, which

consists of making photocopies during 3 hours per day, is not a meaningful goal for him

because this is not a preferred career choice.

Functional means useful; that it, the selected skills should be important and necessary

for the individual at a given time. Again, the individual’s choice of skills to learn is

critical. Skills that the individual needs to learn to access current settings and activities

are important to target. In Peter’s case, a functional goal would be, for example,

learning how to independently get around the college campus by bus (e.g., planning his

trip by using the campus map and the bus schedule).

Age appropriateness of the goals is established by looking at other persons of the same

age. This can help define the activities in which people of the same chronological-age

group engage and the environments in which those skills will be most useful. For

example, when planning Peter’s first day of classes, it would be important to assess the

way other college students are dressed, how their hair is styled, what music they listen

to, and what topics they discuss. Assisting Peter in pursuing age-appropriate goals will

ultimately promote his social skills and help him become friends with people his own

age.

Other experiences that the individual needs will be determined by reviewing the

individual’s long-term goals and vision for his or her future. For example, a person can

be provided with job shadowing experiences to learn about potential careers while also

learning appropriate work behaviors in a volunteer setting. The activities through

which the individual will work towards his or her goals and gain necessary experiences

will then be determined by the types of goals and experiences needed. The end product

of this step is a detailed weekly schedule that specifies the activities, goals, and other

needed experiences for the individual. For example:


Name: Joe

Goals:

1. Work:

a. When using a picture schedule, Joe will be able to complete filing tasks in his

workplace (office), in 3 out of 4 daily opportunities for 5 consecutive days

b. In work situations, Joe will increase the length of time he works before taking a

break from 10 minutes to 30 minutes for 5 consecutive days.

2. Schedule: After listing tasks and activities for the week, Joe will be able to self-

schedule by independently writing the tasks in the appropriate place in his planner

with 90% accuracy as measured on a task analysis, in 3/3 consecutive weekly

sessions.

3. Social: While eating lunch, Joe will reach his social goal of being friendlier at work by

initiating at least one conversation with a coworker in 3 out of 5 opportunities per

week.

Other needed experiences:

1. Career development : Joe will be provided with opportunities to learn about work

and employment options through job shadowing

2. Social: Joe will eat lunch with typical coworkers in volunteer or enclave work

settings.


Joe’s Schedule:

Monday Tuesday Wednesday Thursday Friday

9:00-9:45

Coffee at local

coffee shop

Goal: Social

9:45-10:00

Transportation

9:00-9:15

Transportation

9:15 -12:00-

Enclave work

at local

newspaper

Goal: Work

9:00-9:45

Coffee at local

coffee shop

Goal: Social

9:45-10:00

Transportation

9:00-9:15

Transportation

9:15-12:00-

Enclave work

at local

newspaper

Goal: Work

9:00-9:45

Coffee at local

coffee shop

Goal: Social

9:45-10:00

Transportation

10:00-12:00

Volunteer at

food bank

Goal: Work

10:00-12:00

Volunteer at

food bank

Goal: Work

10:00-12:00

Volunteer at

food bank

Goal: Work

12:00-12:30

Lunch at food

bank

Goal: Social

12:45-1:00

Transportation

12:00-12:30

Lunch in

lunchroom at

newspaper

Goal: Social

12:45-1:00

Transportation

12:00-12:30

Lunch at food

bank

Goal: Social

12:45-1:00

Transportation

12:00-12:30

Lunch in

lunchroom at

newspaper

Goal: Social

12:45-1:00

Transportation

12:00-1:00

Lunch out

Goal: Social

1:00-2:45

Visit local

business

Goal: Career

development

1:00-2:45

Volunteer at

library

Goal: Work

1:00-2:45

Visit local

business

Goal: Career

development

1:00-2:45

Volunteer at

library

Goal: Work

1:00-2:30

Leisure activity

of choice

Goal: Social

2:45-3:00

Transportation

2:45-3:00

Transportation

2:45-3:00

Transportation

2:45-3:00

Transportation

2:30-2:45 Create

schedule for

next week

Goal: Schedule

2:45-3:00

Transportation


Provide: Provide supports and services in a manner that is consistent with the guiding

principles

The services detailed in the schedule should then be provided to the individual.

Instruction in goals should be carried out using effective instructional strategies (see

Section 7) and supports should ensure that the individual becomes as independent as

possible. In the employment and community inclusion sections, we have provided

additional guidance for how supports can be provided in a manner that is consistent

with the guiding principles.

Evaluate: Examine instructional and other data to determine if supports are assisting the

individual to progress towards his or her goals and make changes if needed

Data should be collected on progress towards goals and evaluated at least monthly to

determine whether the services are meeting the individual’s needs. Some questions to

consider are:

Is the individual making progress towards his or her goals?

Are the activities and experiences meeting the needs of the individual?

Does the individual have sufficient work experiences or are medical or

behavioral conditions sufficiently under control for the individual to transition to

supported employment?

Are the individual and his or her family satisfied with the services provided?

If the answer to any of these questions is “no,” you should either a) make changes to

instruction, b) revisit your initial assessment and planning to change the individual’s

goals or activities, and/or c) conduct additional assessment and planning to address

medical and behavioral issues.

Summary

In this section we described the overarching process for developing and implementing

community support services. In the next sections we detail this process by providing

specific examples for employment and community inclusion services.


SECTION 5: EMPLOYMENT SUPPORTS AND SERVICES

Introduction

In this section we discuss the three types of employment services that can be provided:

1. Services to assist individuals in finding employment,

2. Support employment services, and

3. Services to assist individuals in preparing for employment.

Under each of these sub-sections we provide specific examples of how to design and

implement employment services through the process of assessing, planning, providing,

and evaluating.

5.1 Finding employment

General Description

Services can be provided to assist individuals find employment. The goal of these

services is to find paid employment in an inclusive setting. The steps that should be

followed in providing employment finding services are:


Employment finding services begin with assessment of the individual, including

assessment of interests and preferences, previous work experiences, and career

awareness. This assessment can include job sampling experiences in real-life jobs to

further develop the individual’s interests and assess the individual’s abilities in relation

to various jobs. A job profile of the individual should be developed through the

assessment process.

Next, the process of job finding continues by identifying jobs that may match the

individual’s interests and abilities OR by creating a customized job when existing jobs

do not match the interests and abilities of the individual. To identify the jobs that may

be a match for the individual, an analysis of the types of jobs available in the

individual’s community should be conducted. This involves surveying local business,

determining the types of positions in each business, and assessing the availability of job

openings. “Job analysis” of positions that may match the individual’s interests is

conducted, including determining required qualifications or experiences and demands

of the job. Through this process, potential job matches are identified (see the diagram

below). A job is considered a potential match when the individual’s interests,

Step 1. Get to know the individual

Step 2. Identify initial employment interests

Step 3. Assess employment skills and interests through job shadowing and job sampling

Step 4. Create job profile

Step 5. Identify potential job matches and seek competitive employment

OR

Create a customized job


qualifications, experiences, and skills meet the requirements of the job or when

instruction, supports, accommodations, or assistive technology that will enable the

individual to meet the demands of the job can be identified.

When the individual’s interests and abilities do not match the requirements of an

existing job, customized employment should be considered. Customized employment

involves creating an individualized job based on the individual’s unique strengths,

abilities, and interests and the employer’s needs. According to the Office of Disability

Employment Policy, customized employment opportunities are built on four key

elements:

1. Meeting the job seeker's individual needs and interests.

2. Using a personal representative to assist and potentially represent the

individual. This can be a counselor, job developer, advocate, employment

specialist, or other qualified professional.

3. Negotiating successfully with employers.

4. Building a system of ongoing supports for the job seeker.

Whereas supported employment can be viewed as matching a job to the individual,

customized employment can be viewed as matching the individual to a customized job.

Assess the individual

Get to know the person

Identify initial employment

interests

Assess interests and skill

through job shadowing and job

sampling

Create job profile

Assess potential jobs

Analysis of types of jobs in

community

Analysis of potential jobs

Is there a match?

Yes

Possibly

Identify instruction needed

Identify supports/accommodations needed

Identify assistive technology needed

No

Reconsider employment interests

Return to assessment of individual and jobs

Consider customized employment

Adapted from Assess

for Success

(Sitlington, Neubert,

Begun, Lombard, &

Leconte, 2007)


How to Implement

Step 1: Get to know the individual

An important first step in supporting an individual to find employment is to get to

know the individual. Information to be gained through this assessment may include

What activities does the person prefer?

What activities does the person dislike?

What does the person excel in (skills and knowledge)?

How does the person communicate basic needs (asking for help or getting

information)?

Does the person present and communicate in a way that would usually be

perceived as socially appropriate to others (e.g., maintains good hygiene,

initiates interactions, responds to others’ social interactions, respects personal

space, takes turns)?

What are some examples of the type of things the person can do independently?

What are effective strategies for teaching the person a new skill (e.g., prompts,

correction, level of supervision)?

How does the person respond to changes in routine?

Does the person show any emotions or behaviors that might negatively affect

employment? If so, how are these managed in various settings?

How does the person solve a problem?

Does the person generally stay focused on the task at hand?

(adapted from “Autism and the Transition to Adulthood” by Wehman, Smith, & Schall,

2009)

This information can be gathered by spending time with the individual in home and

community settings. Assessment activities should include both those with which the

individual is familiar and also activities that are novel to the individual. Similarly, time

should be spent in both familiar and unfamiliar environments. The goal of this step is

to become familiar with the individual and to develop a relationship in which the

individual is comfortable expressing interests and goals and exploring new

employment options.

For example, Joshua was a 25-year old man with autism. Since leaving high school at

age 21, Joshua had stayed at home with his elderly grandmother. His grandmother had

recently passed away and now Joshua’s family needed to find supports for him during

the day. Joshua expressed a desire to find a job, so his person-centered planning team


decided that job finding services were appropriate at this time. Joshua was receiving

these services Monday to Friday 8:30am-3:00pm.

The employment specialist began by getting to know Joshua. He visited Joshua at home

and spent time with him in community settings. As Joshua would often accompany his

grandmother to the grocery store, bank, and library, these settings were targeted for

assessment. The employment specialist also took Joshua to try some new activities

including going to the movies, shopping at a department store, and visiting a local art

museum.

Through these observations, the employment specialist learned important information

about Joshua such as:

Joshua enjoys trying new activities, however, he prefers settings that are less

crowded

Joshua is interested in reading, watching movies, and learning about art.

Joshua enjoys organizing and putting things in order.

Joshua is interested in learning new skills but is very dependent on prompts

from another adults and rarely initiates tasks by himself

Joshua communicates verbally but is shy and reserved. He enjoys interacting

with others when they initiate the interaction but needs extensive prompting

through these interactions.

Joshua needs his daily schedule to be predictable and does not handle large

changes well (for example, cancelation of activities).

Step 2: Identify employment interests and goals

Once a relationship has been established with the individual, the next step is to begin to

identify initial employment interests and goals. The goal of this step is to identify a

relatively small number of employment options in which the individual is interested.

These options will be explored in greater depth in the following step (job shadowing

and job sampling).

Some useful tools for exploring interests include:

Person-centered planning tools

Interviews with the individual and his/her family and friends

Career interest and preference inventories

Work personality profiles


More specific tools for identifying work interests are provided in the resources at the

end of this section.

For example, for Joshua again, the employment specialist began to identify employment

interests and goals by interviewing Joshua and his mother. Joshua and his mother both

expressed that they would like him to work 5 days a week; however, his mother stated

that working part time at first would be best so that Joshua could get used to working.

Joshua’s mother gave the employment specialist some records from Joshua’s high

school vocational program. In these records, the employment specialist noted that

Joshua had tried janitorial work at the high school and that this was not successful.

When the employment specialist asked Joshua about this type of work, Joshua stated,

“No cleaning.”

The employment specialist also used a work preference inventory from the book “Self-

Directed Employment” by Martin, Mithaug, Oliphint, Husch, & Frazier (2002).In

response to questions from this inventory, Joshua answered that he would prefer a

work environment that is inside, quiet, and doesn’t have too many people in it and that

he would prefer to work in the daytime.

As Joshua was interested in reading and had enjoyed visiting the movie theater and art

museum, the employment specialist targeted working at a bookstore, movie theater, or

art museum as potential employment interests with the goal of part time employment 5

days a week.

Step 3: Assess employment skills and interests through job shadowing and job

sampling

Once a small number of potential employment options have been identified, the next

step is to further assess interests and begin to assess skills at various jobsites through

job shadowing and job sampling. Job shadowing involves learning about a job by

following a person who is already employed in that job. Job sampling involves trying

out the tasks of a particular job in the actual jobsite. Both job shadowing and job

sampling are unpaid, temporary experiences. The goal of this step is to facilitate

informed decision-making regarding employment options.


Job shadowing experiences

For individuals who express clear goals for finding employment, opportunities for

shadowing at the individual’s preferred jobsites should be provided. For individuals

who are unsure of their employment options or interests, a greater amount of time will

be needed to explore various jobs. Opportunities to shadow should be provided to

expose the individual to various employment options. In this way, the individual can

begin to develop an idea of their interests.

Some guidance for arranging job shadowing experiences is provided in the book “Self-

Directed Employment” by Martin, Mithaug, Oliphint, Husch, & Frazier (2002).

To set up shadowing appointments, talk with managers or owners of community

businesses that match the interests of the individual.

When you talk with the employer, introduce yourself and describe your

employment program. Explain to the employer that you are working with an

individual who has expressed an interest in the type of work that his or her

company performs. However, the individual is uncertain about the job duties

and work conditions.

Consider the employer an expert who can provide information about the job.

Ask the employer to assist the individual in exploring this job choice.

Explain that the purpose of shadowing an employee is to provide the individual

with an opportunity to observe the skills and conditions that exist on the job and

to determine the match between the actual job and his or her work preferences.

Explain that you are not there to get a job for anyone at this time.

Explain that both you and the individual you bring are insured by your program.

Schedule a time when the employee who is to be shadowed is working on tasks

that exemplify the job.

Make sure that the time is convenient for the employer and the individual with

whom you are working.

During the job shadowing experience, the individual should observe the employee

performing his or her job. Support should be provided for the individual to ask

questions about the job requirements. It is useful to prepare questions ahead of time

and to take notes during the observation.

Following the job shadowing experience, the individual should revisit the initial

assessment of employment interests and discuss whether the job matches his or her

interests and goals. Some questions to ask include:


Was this job what I expected?

Does this job match my preferences?

What did I like about this job?

What did I dislike about this job?

Could I see myself doing this job?

For individuals who do not communicate verbally, you may want to use pictures,

observation of body language and nonverbal behavior, or other methods to assess their

interests and preferences. Job shadowing experiences should continue until a particular

job or a small number of jobsites which the individual would like to sample have been

identified.

For Joshua, the employment specialist decided that job shadowing experiences were

needed first. Joshua had no work experience and limited exposure to jobs. Job sampling

experiences were arranged to expose Joshua to the following jobs:

Sales assistant at bookstore #1 (large chain store)

Stockroom assistant at bookstore #1

Sales assistant at bookstore #2 (small independent store)

Ticket seller at movie theater

Ticket checker at movie theater

Front desk assistant at art museum

Exhibits assistant at art museum

Joshua visited each of these worksites 3 times and spent at least one hour observing an

employee each time. The employment specialist summarized Joshua’s reactions to these

job shadowing experiences:


Job I liked… I disliked… Could I see myself

doing this job?

Sales assistant at

large bookstore

Working with

books

Too noisy and

crowded

No

Stockroom assistant

at large bookstore

Working with

books

Quiet

Organizing books

Nothing Yes

Sales assistant at

small bookstore

Working with

books

Quiet

People asking me

questions

No

Ticket seller at

movie theatre

Sitting in quiet

booth

Selling tickets

Sometimes busy Maybe

Ticket taker at

movie theatre

Sometimes quiet Too noisy and

crowded at times

No

Front desk assistant

at art museum

Mostly quiet

Selling tickets

Nothing Yes

Exhibits assistant at

art museum

Organizing papers

Learning about art

Too difficult – I

didn’t know what

they were doing

Maybe

Following these experiences, it was clear that working in the stockroom at the large

bookstore, selling tickets at the movie theater, or as a front desk or exhibits assistant at

the art museum were strong employment interests that could be targeted for further

exploration.

Job sampling experiences

For individuals who have clear employment goals, job sampling experiences should be

arranged in jobsites that have the potential to lead to employment. Job sampling can

provide an opportunity for the individual to demonstrate to the employer that he or she

is capable of doing a job for which the employer is hiring. For individuals who are

unsure of their employment goals, job sampling experiences should be arranged in 2-3

jobsites in order to further develop interests and goals. Through these experiences,

individuals can gain work experience and learn more about their work preferences and

interests. These experiences allow the employment specialist to assess the skills that the

individual has and identify the types of supports and training that will be needed for

the individual to be successful in supported employment.


Guidance on arranging job sampling or internship experiences is offered in the book

“Self-Directed Employment” by Martin, Mithaug, Oliphint, Husch, & Frazier (2002).

Find potential job sampling sites through newspaper classified ads, phone books,

Chamber of Commerce publications, friends and family, or past employers.

Contact prospects by phone or in person. Introduce your organization to the

employer.

Tell the employer that the individual you are working with is interested in

determining whether his or her skills match a job at the employer’s site.

Indicate to the employer that an internship allows the individual to determine

whether his or her skills match the job. The internship also provides an

opportunity for the employer to prescreen a potential employee. However, make

sure the employer realizes that, at this point, the individual is not asking for a

job.

Explain that the individual will receive wages from your program or will not be

paid (ensure that you are in compliance with labor laws for employment

experiences).

Be prepared to answer questions from the employer about liability and

workman’s compensation insurance. If your program is paying the internship

wages, assure the employer that your insurance will cover these items. The

employer may ask for proof of insurance.

Set up an appointment for the employer to meet the intern.

The job sampling experience should take place over a specified number of days. During

the experience, the individual should be supported to perform the requirements of the

job. Some important things to assess during the job sampling assessment are:

Does the individual enjoy doing the job?

Which tasks can the individual already perform?

Which tasks will the individual need support and/or instruction to perform?

Is the jobsite welcoming to the individual?

Are there any aspects of the job or the work environment that would be

problematic?

Following the job sampling experience, the individual should again revisit their initial

employment interests and goals. Some questions to ask are:

Was this job what I expected?

Does this job match my preferences?


What did I like about this job?

What did I dislike about this job?

Could I see myself doing this job?

The process of job sampling should continue until the individual has a clear idea of the

job that they are looking for.

For Joshua again, the four jobs identified through job shadowing (working in the

stockroom at the large bookstore, selling tickets at the movie theater, or as a front desk

or exhibits assistant at the art museum) were targeted for job sampling. Joshua’s

schedule for job sampling was:

Monday Tuesday Wednesday Thursday Friday

Bookstore 10-

1pm

Art museum

(ticket seller)

10-1pm

Movie theater

12-3pm

Art museum

(exhibits

assistant) 10-

1pm

Community

activities

This schedule was followed for 3 weeks. At each worksite, Joshua worked with one

employee to complete the requirements of the job. At the end of the job sampling

period, the employment specialist again summarized Joshua’s reaction to these jobs:


Job Positive aspects Negative aspects Potential for

employment?

Stockroom assistant

at bookstore

Enjoyed job

Quiet, not crowded

Work at own pace

Could learn tasks

easily

Welcoming jobsite

None Yes

Ticket seller at

movie theater

Sometimes quiet,

not crowded

Could learn tasks

easily

Enjoyed job

somewhat

Working alone

Can get busy at

times

No opportunities

for daytime

employment at

present

Maybe

Front desk assistant

at art museum

Sometimes quiet,

not crowded

Could learn tasks

easily

Enjoyed job

Can get busy at

times

Would require

extensive

instruction in social

interaction

No current

opportunities for

employment

Maybe

Exhibits assistant at

art museum

Enjoyed working

with art

Enjoyed interacting

with coworkers

Welcoming jobsite

Further education

needed to qualify

for job (basic college

courses, art courses)

Would require

extensive

instruction to learn

job tasks

Yes but college

courses needed first

It was clear from these experiences that Joshua enjoyed working in the stockroom at the

bookstore and as an exhibits assistant at the art museum best. Both of these positions

matched his interests in reading and art, his preference for a clean and quiet work

environment, and his strengths in organizing and working at his own pace. However,

as the job at the art museum required some college education, Joshua’s team agreed that

working at the bookstore should be his current employment priority while he takes


classes at the local community college with a goal of working at the art museum once he

is appropriately qualified.

Step 4: Create a job profile

A job profile is a summary of the individual’s interests, experiences, and preferences in

relation to work. This document is similar to a resume and may be given to potential

employers. The job profile should summarize the following information:

Identifying information

Education

Work experiences (including paid employment, job sampling or internship

experiences, job shadowing experiences, volunteer experiences, and jobs

performed for others or at home)

Life activities and experiences

Strengths in relevant skills

Work preferences and goals

Learning characteristics and accommodations needed

Potential resources or connections

The following is an example of a brief completed job profile for Joshua

Name: Joshua Clark

Date of birth: 01/14/1985

Address: 289 Anywhere St, Somewhere, PA

Education: High school graduate (2006)

Work experiences:

Somewhere Art Museum

Job sampling experiences: Front desk assistant (3 hours per day, total 3 days), Exhibits

assistant (3 hours per day, total 3 days)

Job shadowing experiences: Front desk assistant (2 hours per day, total 3 days), Exhibits

assistant (1 hours per day, total 3 days)

Books R Us

Job sampling experiences: Stock room assistant (3 hours per day, total 3 days)

Job shadowing experiences: Stockroom assistant (1 hour per day, total 3 days), Sales

assistant (1 hour per day, total 3 days)


ABC Movie Theatre

Job sampling experiences: Ticket seller (3 hours per day, total 3 days)

Job shadowing experiences: Ticket seller (1 hours per day, total 3 days), Ticket taker (1

hour per day, total 3 days)

Jennifer’s Bookstore

Job shadowing experiences: Sales assistant (1 hour per day, total 3 days)

Life activities and experiences:

Weekly attendance at book group at library

Played on Special Olympics basketball team 2004-6

Enjoys reading, watching movies, and learning about art

Strengths:

Reliable, hard worker

Loves organizing

Willing to learn new skills

Work preferences and goals:

My goal is to find part-time employment 5 days a week

I prefer a quiet and not crowded work environment

Learning characteristics and accommodations needed:

I will need some help to learn the requirements of the job from my employment

specialist.

Potential resources or connections:

Books R Us: Job sampling/shadowing experiences with this employer. Manager said to

contact when looking for paid work.

Art museum: Job sampling/shadowing experiences with this employer. Manager said to

contact when looking for paid work.

A link to website with more information and examples of vocational profiles is

provided in the Resources at the end of this section.

Step 5: Job finding

a) Identify potential job matches and seek employment


Once potential jobs have been identified and a job profile developed, the job seeking

process can begin. The goal of this process is to create a good match between the

individual and an available job. A number of methods can be used to seek available jobs

including visiting CareerLink offices, looking in the newspaper, or approaching

employers in person or on the phone to enquire about openings. As one of the most

useful ways to find available jobs is through personal connections, it is a good idea to

ask the individual’s family and friends if they have any connections with employers for

jobs that match the individual’s interests.

Some important considerations when seeking available jobs are:

Location and transportation – can the individual get to the workplace easily?

Hours – will the individual be able to work at all required times (e.g., evenings,

nights, weekends, holidays)?

Pay – will the pay be sufficient to meet the individual’s needs?

Before applying for a particular job, it is useful to conduct a job analysis to determine

whether the job will be a good match. Job analysis involves analyzing all relevant

characteristics and requirements of a job in order to create a good match for the

individual. A number of job analysis forms are available online (as an example, see:

http://www.fiu.edu/~dubitsky/job%20analysis%20form%202.%20from%20web.pdf). To

conduct a job analysis, an employment specialist requests permission from an employer

to visit the worksite and observe employees performing the job, similar to job

shadowing. Relevant information should also be gathered through interviews with

employees and supervisors. It can be helpful to keep completed job analysis forms on

file so that they can be accessed by other job seekers.

It is important for the individual to be actively involved in the job seeking process.

Individuals may require instruction and/or coaching in skills such as

Seeking available positions

Enquiring about available positions

Asking for an application

Completing an application

Preparing for a job interview

These skills should be taught using effective instructional procedures (see Section 7).

For Joshua again, the employment specialist contacted the manager of the bookstore at

which Joshua had job shadowing and job sampling experiences. The manager had been

identified as a possible connection in Joshua’s job profile, and a part time job was

available. Before beginning the job, the employment specialist visited the worksite again

http://www.fiu.edu/~dubitsky/job%20analysis%20form%202.%20from%20web.pdf


to conduct a job analysis of this part time position. The analysis was completed by

interviewing the assistant manager and observing other employees performing the job.

This analysis would help to ensure that the position at the bookstore would be a good

match. Below is an excerpt from the job analysis:

Note: This job analysis format is based on the job analysis form by Sitlington, Neubert,

Begun, Lombarde, and Leconte (2007)

Job title: Part time stockroom assistant

Job location: Books R Us

Address: Anywhere Mall, Mall Road

Phone: 555-123-4567

Nature of business: Book retailer

Number employed: 25

Person interviewed: Jane Rodriguez, Assistant manager

Date: February 22, 2010

A. BASIC QUALIFICATIONS

1. Age Minimum 18

2. Experience At least 6 months retail experience preferred

3. Tests None

4. Application Needed

5. Health

requirements

No medical exam, drug testing required

6. Physical

requirements

a. Hearing: Needs to be average

b. Eyesight: Important

c. Speech: Needs to be average

d. Strength: Needs to be average

e. Endurance: Needs to be average

Comments: Job involves standing at all times other than

breaks

Demands Much Little None

Lift X

Carry X

Push X

Pull X

Walk X


Climb X

Stoop X

Kneel X

Crouch X

7. Educational

requirements

High school diploma required

8. Essential skills Skill Much Little None

Travel X

Telephone X

Customer

relations

X

Supervisor

relations

X

Employee

relations

X

Comments: Job takes place mainly in stockroom but mat

be asked to work on shop floor on busy days

B. WORKING CONDITIONS

Wages Paid by check bimonthly, starting rate $8/hour

No overtime or holiday pay for part time work

Hours 18 hours per week

Days Three days per week

Length Year-round

Benefits Not provided

Work environment Indoor

Quiet -average noise level

Well-lit

Work with few others

Much supervision from stockroom manager

Some on-the-job training provided

C. WORK PERFORMED

Duties and responsibilities of job:

Follow instructions from stockroom manager

Return books to correct place in stockroom

Unpack boxes and place books in correct place in stockroom

Pack boxes of books to be returned

When store is busy return books on shop floor to correct place on shelves


Based on the job analysis, it was decided that working as a stockroom assistant was a

good match for Joshua’s current interests and strengths. Joshua was hired to work part

time three mornings a week. However, as Joshua’s goal was to work 5 days a week, the

employment specialist also helped Joshua to seek similar employment at other

bookstores in the area. Joshua needed instruction and support in completing

applications and preparing for interviews. As Joshua was very interested in working at

the art museum, Joshua also decided that he would like to start taking college classes so

that he could gain the qualifications he would need to eventually apply for this job. To

keep his foot in the door, Joshua began volunteering each week at the art museum.

b) Create a customized job

When an individual’s interests and goals do not match an existing job, customized

employment should be considered. Customized employment involves creating an

individualized job based on the individual’s unique strengths, abilities, and interests

and the employer’s needs.

The customized employment process involves:

1. Discovery – getting to know the individual and his or her employment interests and

goals (similar to step 1 and 2 above).

2. Developing a vocational profile (similar to step 4). For customized employment, the

profile should include greater description of the individual’s talents and strengths

that could be capitalized upon to create a customized job. The profile should also

specify the tasks that the individual could perform, identify potential employers to be

contacted, and outline the supports that will be necessary for the job to be successful.

This profile is often developed during a meeting with the individual and his or her

family and friends.

3. Negotiating with an employer to create a customized job. This begins with getting to

know employers in order to understand how businesses work and what their needs

are. Next, consider in what ways the individual could benefit the business. Some

options for customized jobs include:

Job carving. A job description is created by modifying an existing job

description. The carved job description contains one or more, but not all, of the

tasks from the original job description.

Negotiating a job description. Several tasks are selected from all the tasks

performed at the workplace to create a new, individualized job description.


Job creation. A newly created job description is negotiated based on unmet

workplace needs.

Job sharing. Two or more individuals share the tasks and responsibilities of a job

based on each other’s strengths.

Self employment. The individual sets up his or her own business to provide a

service to an employer.

(adapted from ODEP, 2005)

A proposal should then be made to the employer specifying the job that the

individual could perform and how this would benefit the business.


Case Study

”John came to the CAAPP at Devereux CARES with no employment portfolio and little

information on previous employment, thus requiring extensive job assessment and

training. We began by getting to know John and his needs through both interview and

observational assessments. We found out from his family what he enjoyed doing and

also observed his employment skills, including greetings, on-task behavior, and

hygiene. He showed initial interest in being a greeter in an apartment building or local

department store. He observed this job at an apartment building and also tried to greet

residents. Based on assessment, it was determined that this may not be an appropriate

fit. John then participated in a paid job-training program in a cafeteria. This setting

allowed him to learn job-related skills, especially punctuality, workplace attitude, skill

fluency, and improving his on-task behavior. After six months, he was ready to move

to a different job closer to his house and in a more preferred environment. Through

different tasks and sampling he was able to narrow down his preferences. Based on his

interests, he began working at his local mall in a drugstore. Through travel training

with our program, he was able to learn how to take the bus in the morning and pick it

up in the afternoon.”

Forms (see Appendix: Forms)

Job profile

Job analysis

Resources:

Website: CareerZone Pennsylvania (www.pacareerzone.com) for assessments, videos of

various careers, and other useful tools that can be used for individuals to explore their

interests.

Visit your local CareerLink office for additional support in exploring interests (see

http://www.paworkforce.state.pa.us/professionals/lib/professionals/contactus/CareerLi

nks.htm for a list of locations)

Book: Pennsylvania Career Guide

(http://www.paworkstats.state.pa.us/carguide/CG_08-09.pdf)

A number of useful forms for identifying interests can be found in the book “Self-

Directed Employment” by Martin, Mithaug, Oliphint, Husch, & Frazier (2002).

http://www.pacareerzone.com/

http://www.paworkforce.state.pa.us/professionals/lib/professionals/contactus/CareerLinks.htm

http://www.paworkforce.state.pa.us/professionals/lib/professionals/contactus/CareerLinks.htm

http://www.paworkstats.state.pa.us/carguide/CG_08-09.pdf


Additional examples of vocational profiles can be found at this website:

http://ruralinstitute.umt.edu/transition/vocationalprofile.asp

A job analysis form can be found in Assess for Success: A practitioner’s handbook on

transition assessment, by Sitlington, Neubert, Begun, Lombard, and Leconte (2007)

A guide to customized employment including strategies for negotiating with employers

and a sample employment proposal is provided in: Customized Employment: Practical

Solutions for Employment Success (Volume 1) and Customized Employment: Applying

Practical Solutions for Employment Success (Volume2) (Office of Disability

Employment Policy, 2005). Available at:

http://www.dol.gov/odep/categories/workforce/CustomizedEmployment/deliverables/i

ndex.htm

Checklist for Finding Employment

Guiding principle Key indicators

1. Driven and guided by the

individual and his/her

family

Throughout the job seeking process, the

individual’s interests and preferences are

considered above all other factors.

2. Promote self-determination

and self-advocacy

Job seeking process allows the individual to make

choices regarding potential jobs, places to apply

to, and ultimately to decide which job to choose.

Instruction in interview skills includes instruction

in self-advocacy

3. Individualized

Appropriate job matches are made based on

assessment of the individual and analysis of the

work site

4. Provided to participate in

every aspect of socio-

cultural life

Employment is sought in inclusive settings

5. Based on a philosophy of

acceptance

Services are provided that capitalize on the

individual’s strengths

http://ruralinstitute.umt.edu/transition/vocationalprofile.asp

http://www.dol.gov/odep/categories/workforce/CustomizedEmployment/deliverables/index.htm

http://www.dol.gov/odep/categories/workforce/CustomizedEmployment/deliverables/index.htm


Opportunities are not limited because of the

individual’s diagnosis

6. Respectful and age-

appropriate

Supports for finding employment are provided in

a nonintrusive and respectful manner (e.g., not

disclosing disability, allowing the individual to

speak for his/herself)

7. Promote the full inclusion

of individuals in their

communities

Employment is sought in inclusive settings and in

the individual’s community

8. Promote independence and

foster interdependence on

naturally occurring

supports in the individual’s

environments

Job seeking services allow the individual to be as

independent as possible (e.g., inquiring about

available positions, completing applications,

interviewing)

Whenever possible, typical job finding services

are accessed by the individual

9. Culturally responsive Employment is sought that fits within the

individual’s cultural values

10. Provided with integrity

and quality

Observations are conducted periodically to ensure

the quality of these services

5.2 Supported employment

General Description

Supported employment services are provided to individuals who are currently

employed in an inclusive, competitive job or in a customized job in an inclusive setting.

The goal of these services is to maintain the paid position by carrying out all job

requirements. These services are typically provided by a job coach or employment

specialist who is assigned to work either individually or with several individuals

employed at the same worksite. Supported employment services include assessing the

support needs of the individual in the work setting, supporting the individual to fulfill

the requirements of the job and to be integrated into the work environment, and

transferring supports to natural supports within the work environment. As such, the


following guidelines for supported employment can also be applied to individuals in

customized employment.

How to Implement

Assessing support needs

Step 1: Assess the requirements of the job and workplace culture. Begin by talking

with the individual’s direct supervisor to determine what tasks are required for the job.

Also discuss the general requirements of the job, such as disposition, appearance, etc.

Next, talk to coworkers who are familiar with the particular job tasks to determine what

specific steps are required for each task. Through observation, identify skills that are

important for success and inclusion in the work setting, such as skills for interacting

with coworkers and supervisors. The goal of this step is to develop a task analysis of

each essential job task and to determine what skills are important for success in the

work setting.

Step 2: Assess the individual’s ability to complete job requirements and to fit in with

the workplace culture. Through situational assessment (see Section 7), determine which

steps of each job task analysis the individual is able to complete independently and

which will require instruction. Also determine which of the general job requirements

and other important skills for inclusion in the workplace the individual will be able to

meet and which will require instruction or support.

Step 3: Plan for instruction and supports. Identify and prioritize critical skills for

performing job tasks and ensuring inclusion in the work setting. Using effective

instructional procedures (see Section 7), develop a plan for systematic instruction in

these skills. It may also be useful to provide information to coworkers regarding the

individual’s strengths and support needs.

Providing supports

A balance must be found in providing supports in the work setting: Too much support

can be stigmatizing and will not allow the individual to become independent in the job

requirements or included within the workplace culture; too little support can put

continued employment at risk. The following guidelines are provided for providing

supports in the work setting:

Work Support


Existing supports natural to the work environment are maximized for training and

ongoing support. Artificial training or programs to change behavior considered highly

unusual by the work culture of the job setting are minimized. Teaching techniques

which may convey poor images, stigma, or devalued status are not used. Best training

practices and technology appropriate to the setting and culture are utilized.

Appropriate evaluations and outcome measures are provided. Specialized jargon from

the disability field is minimized. At all times, the business culture is respected and

integrated into the support network for the individual to succeed. Use of

accommodations, technology, or other job modifications needed are explored and

developed in consideration of their potential for success, non-intrusiveness, and

generalization to other life domains.

From The Association for Persons in Supported Employment’s

“Ethical Guidelines for Professionals in Supported Employment”

http://www.apse.org/docs/EthicalGuidelines.pdf

Building natural supports and fading paid support

The goal of supported employment is to maximize the independence of the individual

and foster interdependence on supports that are available to all workers in the

workplace. Building natural supports is an important process for reducing the

individual’s dependency on the employment specialist. Once instruction has been

provided to allow the individual to perform the requirements of the job as

independently as possible (or even while this instruction is being provided), the process

of building natural supports should begin to transfer support from the employment

specialist to other supports in the work setting.

Step 1: Identify sources of natural support and determine which are preferred by the

individual. Natural supports can be found in a number of places in the work setting

including:

Coworkers to train, prompt, and monitor

Supervisors to train, prompt, and monitor

Company trainings (both in-person and video) for all employees to train

Job duty checklist provided by the employer to prompt

Human resources to provide support, counseling, and information



While providing supported employment services, the employment specialist should

observe for potential sources of natural support. Some questions to consider are:

Which coworkers are able to monitor the individual?

Which coworkers seem interested in interacting with the individual or have a

relationship with the individual?

Which coworkers does the individual prefer?

Which supervisors are able to monitor the individual?

Which supervisors does the individual prefer?

What trainings are offered to all employees? What additional trainings are

available on videotape or online?

What supports can human resources offer the individual?

Step 2: Develop strategies for accessing potential supports. Coworkers and

supervisors may be unfamiliar with the individual’s needs and ways in which they can

offer support. These persons will likely need some training and/or coaching to be able

to support the individual. The employment specialist can train coworkers by modeling

strategies for assisting the individual. The employment specialist can also help

coworkers by demonstrating effective ways to communicate and interact with the

individual. In some situations, and always with the permission of the individual and his

or her family, the employment specialist may need to explain to coworkers the

characteristics of ASD and how these affect the strengths, needs, and behaviors of the

individual. In addition to training, the employment specialist can promote a positive

view of the individual by instructing coworkers and supervisors to direct questions and

instructions to the employee with ASD rather than the employment specialist and by

encouraging the individual to interact with coworkers and supervisors rather than

relying on the employment specialist to carry out this interaction.

Step 3: Evaluate. Once natural supports are in place periodic evaluation of whether

these supports are working should be conducted. Information can be gathered through

Talking with supervisors and coworkers

Asking supervisors to complete evaluations of the individual

Observing the individual to determine whether he or she is performing the

requirements of the job or if there are any unmet needs

Some questions to ask during this evaluation are:

Is the individual completing the requirements of the job satisfactorily?

Are coworkers happy with the level of support that they need to provide?

Are coworkers willing to continue providing support?

Are supervisors willing to continue providing support?


Are there any needs that are not being met through natural supports (e.g.,

training needs)?

When issues are identified in any of these areas, revisit the strategies for accessing

support and determine what changes can be made. For example, a different coworker

may be more willing to monitor the individual, coworkers or supervisors may need

additional training, or the individual may need to be taught a skill through direct

instruction from the employment specialist. This process should continue until it is

determined that the employment specialist can begin to fade his or her support.

Step 4: Fading supports. For some individuals it will be possible to fade the support of

the employment specialist from full-time support to periodic check-in support. In these

cases, a plan should be developed for this transition. To begin with, the employment

specialist could remain present at the worksite but in a different area from the

individual. If this is successful, the employment specialist could reduce the number of

hours that he or she is present at the worksite. A supervisor should be provided with

contact information for the employment specialist should issues arise. Finally, the

employment specialist could fade his or her support to checking-in periodically, such as

once a week or once a month. The plan for fading support should specify

Each phase of support (e.g., full-time, on-site full-time, on-site for 10 hours per

week, weekly check-in)

Criteria for transitioning to each phase of support and for reinstating additional

support

Sources of support that the individual can access other than the employment

specialist

Plan for how the employer can get in contact with the employment specialist

Methods of evaluation


Case Study

”In revisiting John’s story (see section 5.1), once he was at his job in the mall, it was

important to not only use the paid employment supports but also to start to establish

natural supports. In order for this to occur, the job coach and employment specialist

had to partner with the staff the drugstore where John worked. This process began

early on and was an important consideration when finding John a job initially. In this

case, John’s store manager also had a son with special needs and therefore made a great

natural support in his current job. His job coach initially remained on the job, but over

time was able to fade out while the store manager took more responsibility in

scheduling and showing John the store tasks. This required the job coach to maintain a

good working relationship with the store manager and other store personnel.

Additionally, checklists were developed to prompt John to complete tasks, and the

employer was able to easily update the checklists. John is very happy in his current

placement and will likely remain here indefinitely, as he was recently given more

responsibilities in the store.”

Resources:

1. Book: Trach, J. S., & Shelden, D. L. (1999). Natural supports: A foundation for

employment. Washington, DC: American Association on Intellectual and

Developmental Disabilities.

Available at https://bookstore.aaidd.org/BookDetail.aspx?bid=42#toc

2. Book: Wehman, P., Inge, K. J., W. G., Revell, & Brook, V. A. (Eds.) (2007) . Real

work for real pay: Inclusive employment for people with disabilities. Baltimore,

MD: Paul H. Brookes.

3. Document: Supported Employment Quality Indicators

http://www.apse.org/docs/QualityIndicators.pdf

Checklist for Supported Employment




family

Assessment includes consideration of the

supports desired by the individual.

Supports are provided in a manner consistent

with the desires of the individual.

https://bookstore.aaidd.org/BookDetail.aspx?bid=42%23toc%20

http://www.apse.org/docs/QualityIndicators.pdf


Natural supports match the preferences of the

individual.


and self-advocacy

Includes supports to allow the individual to self-

advocate in the work setting (e.g., disclose

disability, request accommodations, request

changes to certain aspects of the job)

3. Individualized Assessment is conducted for each individual in

the work setting.

Supports are planned on an individual basis



cultural life

Assessment includes consideration of all aspects

of the work environment including social


acceptance






appropriate

Supports are provided in a nonintrusive manner

and are respectful of the individual (e.g., not

disclosing disability, speaking positively about

the individual to coworkers)



communities

Supports provided to allow the individual to be

fully included in the work setting.

When supports are needed, natural supports are

developed in the work setting



naturally occurring


environments

Supports include instruction to perform at the

maximum level of independence.

Naturally occurring supports are built in order

to fade paid supports as much as possible


9. Culturally responsive Assessment takes into account the individual’s

culture and the culture of the workplace

Supports are provided in a manner that is

consistent with and respectful of the

individual’s culture


and quality

Periodic observations of supports provision

Feedback from supervisors in the work setting

to assess satisfaction with employee and

supports provider

5.3 Preparing for competitive employment

General Description

Transitional work services are temporary services provided to individuals who need

support to transition to competitive or supported employment in integrated settings.

Individuals who access these services may have no work experiences or may exhibit

behaviors or medical conditions that prevent them from seeking employment at the

present time. These individuals need longer to prepare for competitive or supported

employment in integrated settings. We wish to emphasize that competitive or

supported employment should always be the goal, but for certain individuals a period

of preparation for work that is longer than that which can be provided under supported

employment services may be necessary. Transitional work services are not appropriate

for individuals who have no behavioral or medical conditions that prevent them from

working or who have adequate prior work experiences to qualify for jobs that match

their career goals. For individuals who receive these services, regular evaluation of

progress must be conducted to determine if these services are still warranted.

Transitional work services are provided either 1:1 or to small groups of individuals.

These services should be based on an individual assessment of the needs, preferences,

and interests of the individual. Furthermore, services that are provided to small groups

must be carefully planned to match the needs, preferences, and interests of all

individuals in the group. Transitional work services are provided solely in community

settings rather than in segregated vocational facilities such as sheltered workshops or

training centers.


How to Implement

Step 1: Get to know the individual

Before decisions are made regarding the types of services that will be provided to the

individual, it is important to get to know the person. The goal of this step is to develop

a clear understanding of the individual’s strengths, interests, preferences, and past

experiences as well as the needs for which the individual requires transitional work

services. This information will be used to determine what services the individual

requires and what work experiences would be most appropriate.

This information can be gathered through a number of methods including:

Spending time with the individual

Interviewing the individual and his or her family, friends, and previous teachers

or support workers

Reviewing past records

Conducting preference assessments

Some questions that should be asked include:

What are the individual’s strengths?

What are the individual’s interests?

What are the individual’s preferences?

What prior experiences has the individual had in relation to employment,

education, or community living? How successful were these experiences?

Has the individual engaged in challenging behaviors that are impeding

employment or inclusion in community settings?

Does the individual have any complex medical needs?

This information should then be summarized in an assessment report.

Step 2: Develop a daily schedule specifying goals and activities

Once you have a clear understanding of the individual’s interests, preferences, goals,

and needs, the next step is to determine what the goals will be for transitional work

services and through what activities and experiences these goals can be met. In general,

the purpose of transitional work services is either a) to provide work experiences and

develop skills for individuals who have no prior experiences and therefore few

employment skills, and/or b) to get behaviors or medical conditions that prevent the


individual from being successfully included in work or other community settings under

control. It is important to have a clear understanding of the purpose of transitional

work services for each individual, although the types of activities and experiences that

are provided may be the same. Specific goals for this service can then be developed

based on the individual’s needs.

All activities and experiences will take place in community settings. Some options for

work experiences are (from the Bureau of Autism Services service definitions):

Mobile work force – teams of individuals, supervised by a training/job

supervisor, who conduct service activities away from an agency or facility. The

provider agency contracts with an outside organization or business to perform

maintenance, lawn care, janitorial services, or similar tasks and the individuals

are paid by the provider.

Work station in industry – individual or group training of individuals at an

industry site. Training is conducted by a provider training/job supervisor or by a

representative of the industry, and is phased out as the individual(s)

demonstrate job expertise and meet established production rates.

Affirmative industry – operated as an integrated business, where employees both

with and without disabilities work together to carry out the job functions of the

business.

Enclave – a business model where individuals with disabilities are employed by

a business/industry to perform specific job functions while working alongside

workers without disabilities.

Keep in mind that whenever services are provided to groups of individuals as in some

of these models, all activities and work experiences should match the interests and

goals of all individuals in the group.

Some other activities and experiences through which individuals can work on goals for

preparing for employment include:

Volunteer activities – opportunities through which any community member can

offer his or her time and expertise. Volunteer opportunities are undertaken only

in non-profit organizations or projects and in designated volunteer positions,

and must benefit both the individual and the community. No financial payment

is made to any person (either with or without disabilities) carrying out volunteer

work. Some examples include working at the local food bank, shopping or

delivering meals for Meals on Wheels, helping at a library or community theater.


Job shadowing or job sampling – unpaid work experiences through which the

individual develops career awareness. See the “finding employment” section for

more information on these experiences.

Career development activities – these could include visiting local businesses with

the purpose of observing the various jobs that people can have, researching jobs

and careers on the internet, or visiting a CareerLink office to explore job interests.

Social activities – these could include eating lunch or taking breaks with other

volunteers or “coworkers” at employment or volunteer sites.

At the end of this step, you should have a weekly schedule for the individual that

specifies the activities that will take place and the goals that are to be worked on in each

activity (see Section 4).

Step 3: Provide services and evaluate progress periodically to determine if this

service is appropriate

The services specified in the weekly schedule should then be provided. Instruction on

goals should be provided using effective instructional strategies (see Section 7). Data

should be examined at least monthly to determine whether the services are meeting the

individual’s needs. Some questions to consider are:


Are the activities and experiences meeting the needs of the individual?

Does the individual have sufficient work experiences or are medical or

behavioral conditions sufficiently under control for the individual to transition to

supported employment?


Case Study

“Cole came to the CAAPP program after leaving a residential treatment facility. He

was transitioning back home, and when he started the program, he and his family

didn’t think that having paid employment was appropriate at that time. His mom had

tried to start him at a job at the local grocery store, but after a few days without any

successes on the job she enrolled him in our program with the hope that he could

develop and practice employment skills through volunteering and other experiences.

An assessment of Cole showed that he was very good with typing and computer skills.

We enrolled him in an adapted computer course at a local university to further these

skills. Additionally, we began to teach him transportation skills, including accessing

public transportation and studying for a driver’s license. He began participating in

three different volunteer opportunities each week. One opportunity was at a non-profit

office, where he could use his typing skills, filing skills, and practice answering the

phone. Another job was at a local library, which allowed Cole to move around to

various spaces, which was important. The third job was at a local senior center

volunteering to run activities such as bingo, which offered him opportunities to practice

customer service skills. Through a combination of these jobs, computer courses, resume

building, and transportation practice, Cole is developing a solid foundation for his

career portfolio.”

Resources:

More information on volunteer and unpaid work experiences including many useful

forms see the “Work Experience Guide” by Condon and Brown

http://ruralinstitute.umt.edu/transition/Articles/RIWorkExperience_Manual.pdf

Checklist for Preparing for Employment




family

Services and placement decisions are based on the

individual’s interests, preferences, needs, and

goals.


and self-advocacy

Opportunities to express self-determination are

provided each day

Supports are provided for individuals to self-

advocate

http://ruralinstitute.umt.edu/transition/Articles/RIWorkExperience_Manual.pdf


3. Individualized Services for all individuals match their unique

interests, preferences, needs, and goals.



cultural life

Employment or volunteer opportunities are

sought that allow individuals to feel productive


acceptance






appropriate

Supports for preparing for employment are

provided in a nonintrusive and respectful manner

(e.g., disclosing disability only when necessary,

allowing the individual to speak for his/herself)



communities


sought in inclusive settings



naturally occurring


environments

Transitional work services allow the individual to

be as independent as possible (e.g., learning to

work independently)

Whenever possible, natural supports are found in

community settings

9. Culturally responsive Experiences are sought that fit within the



and quality

Observations are conducted periodically to ensure

the quality of these services

Summary

In this section we have described how to design and implement employment services

for adults with ASD. We discussed how the general approach of assessing, planning,

providing, and evaluating works for the three types of employment services: finding

employment, supported employment, and preparing for employment. In the next

section we describe how this process works for community inclusion services.


SECTION 6: COMMUNITY INCLUSION SUPPORTS AND SERVICES

Introduction

In this section we describe how the process of assessing, planning, and providing works

for community inclusion services. These services promote participation in many

different community activities including postsecondary education, leisure and

recreation, and socialization activities.

General Description

Community inclusion supports and services are provided to assist individuals to be

involved in their communities. The goal of these services is increase community access

in order to increase or maintain community inclusion. These services focus on both a)

skill development to teach the skills necessary for participation and b) supports to

ensure that individuals have opportunities for community participation. Services may

focus on a variety of skill areas such as communication, socialization, self-direction, self-

help, and adaptive skills. Supports may include strategies for accessing natural

supports, environmental adaptations, and assistance with arranging opportunities for

community participation.

Activities for which community inclusion supports and services can be provided

include (but are not limited to):

Postsecondary education or adult/continuing education

Volunteer activities

Leisure and recreation activities

Socialization activities including relationship development and maintaining

relationships with friends and family

Cultural and spiritual activities

Exercising civic rights and responsibilities

Use of typical community services available to all people

Activities of daily living (i.e., bathing, dressing, eating, mobility, and using the

toilet)

Instrumental activities of daily living (i.e., communication, survival skills,

cooking, housework, shopping, money management, time management, and use

of transportation)

The selection of activities and settings in which supports and services are provided s

based on an individual assessment of the interests, preferences, and needs of the


individual. Community inclusion supports and services are typically provided 1:1 in

community settings and in the individual’s home (but not a licensed setting). As the

focus of these supports is on increasing access to and participation in community

activities, instruction and other supports will need to be provided in the context of daily

activities. Community inclusion services cannot be provided at the same time

(concurrently) as supported employment or transitional work services or any other non-

community-based service.

How to Implement

Step 1: Get to know the individual and conduct a broad inventory and assessment of

all environments which the individual accesses

The purpose of this first step is to look across all environments in the individual’s home

and community to determine which settings are important to target for supports. Some

questions that are important to ask through this assessment are:

What are the person’s interests and strengths?

In what settings and activities that the person already accesses does he or she

need support?

What other settings or activities does the person envision him/herself?

What supports may be needed to access these settings and activities?

Step 1: Get to know the individual and conduct a broad inventory and assessment of all environments which the individual accesses or desires to access

Step 2: Conduct situational assessments in targeted settings and activities

Step 3: Plan for instruction and supports

Step 4: Provide and evaluate services


This information can be gathered through:

Spending time with the individual in home and community settings

Talking with the individual about his or her dream for the future

Interviewing family members and friends

Conducting preference assessments

The outcome of this assessment should be a list of settings and activities that will be

targeted through your services. For example, for Sally this list included:

Current settings/activities in which

support is needed

Other settings/activities which the person

needs/wants to access

Using the post office

Taking the bus to work

Purchasing groceries

At home, preparing healthy meals

Joining bowling league

Taking adult education class

(photography) at community college

Step 2: Conduct situational assessments in targeted settings and activities

The purpose of this next step is to determine the specific skills and supports that will be

needed for the individual in each of the targeted settings and activities. Situational

assessments should be conducted in each setting and activity to determine:

a) What skills and behaviors are required for each setting and activity

b) Which of these skills and behaviors the person already performs independently

c) Which of these skills and behaviors will require support, either through

instruction or through other methods such as support from persons in the setting

or adaptations to the environment

More information on conducting situational assessments can be found in Section 7. You

will need to conduct situational assessments in all identified current and desired

settings. Each setting should be visited a number of times to gain an accurate

understanding of the needs of the individual and the demands of the environment.

The outcome of this step is a list of skills or behaviors needed for participation in each

setting or activity and a list of other supports that will be needed by the individual.

These other supports can include environmental adaptations (such as checklists that

will be helpful, strategies for organization), supports for steps that the individual is not

expected to perform independently at this time (such as transportation to a particular

location), or supports for steps that occur infrequently (such as registering for a class).


Below are examples of skills and behaviors that may be needed for participation in each

type of setting and activity for which community inclusion services can be provided.

Postsecondary education or adult/continuing education

o Select and register for class

o Purchase necessary books and materials for class

o Get to class at appropriate time

o Have necessary books and materials ready

o Participate in class

o Interact with classmates

o Request help from instructor

o Learn information required

o Complete assignments

Volunteer activities

o Tasks that must be completed

o Get to volunteer site

o Have necessary clothing or materials

o Interact with other volunteers

o Request help from supervisor or other volunteers

Leisure and recreation activities

o Select activities based on interests

o Locate activities in community

o Register for recreational activities

o Get to leisure and recreating settings

o Perform necessary skills for activity

o Interact with others in the setting (e.g., teammates)

o Pay for activities

o Have necessary clothing and materials

Socialization activities including relationship development and maintaining

relationships with friends and family

o Identify persons with whom to build or maintain relationships

o Keep phone numbers/addresses

o Request socialization activities

o Be a good friend

o Be safe


Cultural and spiritual activities

o Identify activities in which to participate

o Get to activities or events

o Participate in activities and events

o Interact with others in the setting

Exercising civic rights and responsibilities

o Register to vote

o Vote

o Attend community meetings

o Engage in political activities

Use of typical community services available to all people

o Locate services

o Use services, (e.g., request services, pay for services)

Activities of daily living (i.e., bathing, dressing, eating, mobility, and using the

toilet)

o Recognize need to perform each activity

o Perform each activity

Instrumental activities of daily living (i.e., communication, survival skills,

cooking, housework, shopping, money management, time management, and use

of transportation)

o Recognize need to perform each activity

o Perform each activity

For example, for Sally again:


Setting/activity Skills/behaviors to target

for instruction

Other supports needed

Using the post office

Recognizing need to buy

stamps

Locating post office

Wait in line

Paying for stamps

Checklist at home to mark

number of stamps left

Taking the bus to the

bowling alley

Familiarity with bus

schedule

Locating bus stop

Wait in line

Paying bus fare

Getting off the bus

Problem solving if bus not

on time

Cell phone to call

teammates if bus is late

Have correct bus fares

ready at home

Purchasing groceries

Recognizing need for

grocery items

Making a list

Making healthy choices

Wait in line

Paying for items

Checklist at home to mark

when items run out

Transportation to grocery

store

At home, preparing healthy

meals

Identifying healthy recipes

Needs to learn 3-4 easy

healthy recipes

Picture recipes for 3-4

meals

Joining bowling league

Appropriate bowling

etiquette

Wait turn

Conversational skills with

team

Paying for bowling

Finding a bowling league

that fits Sally’s schedule

Finding a team

Buying a ball and shoes

Taking adult education

class (photography) at

community college

Getting ready for class

Appropriate in-class skills

(raising hand, paying

attention)

May need further instruction

in photography skills taught

in class

Completing assignments

Finding a class that fits

Sally’s schedule

Registering for class

Buying needed materials


Step 3: Plan for instruction and supports

Once skills and supports needed for targeted settings and activities have been

identified, the next step is to plan for providing instruction and supports. Although the

long-term goal is for the individual to be as independent as possible in these settings

and activities, it may be unreasonable to plan initially for the individual to access these

settings and activities completely independently. Instead, you may want to build

independence by targeting critical skills and behaviors first and finding other ways to

address less important skills. The outcomes of this step are instructional plans for

necessary skills and a plan for providing other supports. This can be achieved through

the following iterative process.

First, decide which skills and behaviors are critical to target through instruction at this

time. In each setting or activity, prioritize those skills which are essential for the

individual to learn. Take into consideration the learning style of the individual and

amount of time and instruction you anticipate it will take for the individual to learn

each skill. We recommend that you target no more than 2 or 3 skills or behaviors in each

setting or activity at a time. For these targeted skills and behaviors, develop

instructional plans (see Section 7 for guidance).

Next, decide which other skills and behaviors are necessary for participation but will

not be targeted for instruction at this time. Plan for how these skills can be completed

without requiring independent completion by the individual. To achieve this, you may

need to revisit the settings and activities to determine what supports are available to all

persons in the environment. Some possible support strategies include:

a) Persons already in the setting complete the skill (natural supports)

b) Environmental adaptations are made so that the skill is not necessary

c) The support staff uses partial participation to allow the individual to participate

in some aspect of the skill

d) The support staff completes the skill

You should take into consideration the preferences of the individual for how these

supports will be provided. For these other skills, develop support plans (see Section 7).

Then, once the individual begins to reach mastery on the initial target skills, revisit the

first planning step and select the next skills and behaviors to target for instruction.

For example, for Sally in the activity of taking the bus to the bowling alley, it was

decided that critical skills to target for instruction initially were:

1) Waiting in line


2) Paying bus fare

Instructional plans were developed for these two skills. These included the

environmental adaptation that individual bus fares were put in envelopes in Sally’s

home.

As Sally’s neighbor rode the same bus at the same time each Saturday, it was

determined that the neighbor could help Sally:

1) Get to the bus stop

2) Problem solve by reminding her to call her teammates if the bus was late

The instructional support staff assumed responsibility for:

1) Knowing the bus schedule

2) Indicating to the bus driver for the next bus stop

As Sally become proficient in waiting in line and paying the bus fare, it was decided

that the next steps for Sally to learn were

1) Knowing the bus schedule

2) Indicating to the bus driver for the next bus stop

Once you have identified goals and planned for instruction and supports, develop a

detailed weekly schedule that specifies the activities, goals, and other needed

experiences for the individual (see Section 4).

Step 4: Provide and evaluate services

The services detailed in the weekly should then be provided. Data should be collected

on both instruction and supports provision. This data should be examined at least

monthly to determine whether the services are meeting the individual’s needs. Some

questions to consider are:

Is the individual participating in community settings and activities?


Are there any other skills or behaviors that need to be targeted for instruction or

support at this time?

Are there any other settings or activities which the individual needs or desires to

access?

Is the individual happy with the services he or she is receiving?

Services should be modified as necessary based on this periodic evaluation.


Case Study

“Emily had graduated high school but she and her family weren’t sure where to go

next. Emily tried to take courses at a local community college and become involved in

her local community, but found this to be difficult and mostly unsuccessful. She ended

up at home most days without employment or any other activities, which led to

additional isolation, depression, and anxiety.

By meeting with Emily and her family, we were able to determine what her preferences

were and identify barriers that were currently keeping her from the local community.

This was accomplished by listening to Emily and her family and also observing her at

home and out in the community. One issue was transportation, but through the proper

travel training, we were able to help Emily learn to take the bus to various places, even

learning transfers. We also were able to secure funding for transportation through her

waiver.

By knowing and understanding Emily’s preferences, we were able to find her a

volunteer position at the local library and through observation, we were able to

determine the skills that Emily already knew how to do and where she may need

additional help. Through one-on-one assistance, Emily was able to learn how to

complete a job at the local library and take public transportation independently to get

there. Additionally, we worked with Emily to recognize how to make healthier meal

choices, in order to avoid health problems that were starting to form due to a poor diet.

She began learning to budget her money and go to the grocery store to shop for healthy,

affordable foods. With our help, Emily became even more involved in her favorite

sport, cup-stacking, and began utilizing our services to attend cup-staking tournaments;

currently, she is the state-record holder for her age group. Building on Emily’s interest

in art, she began to attend free, local community art classes once per week. She enjoys

these classes and has developed a friendship with instructor, who in turn invites her to

participate as an usher in the shows at the local theater. These types of natural supports

and connections are often vital to the success of community integration.”

Checklist for Community Inclusion




The individual decides in which settings and

activities he or she wants support


family


and self-advocacy

Whenever appropriate, the individual is

encouraged to self-advocate for his or her needs

and rights in community settings

3. Individualized Community inclusion services are based on an

individual assessment of the interests,

preferences, and strengths of the individual



cultural life

When conducting an inventory of settings and

activities in which supports may be needed, all

aspects of community life are considered


acceptance






appropriate

Supports are provided in a manner which treats

the individual with dignity


activities in which supports may be needed,

activities in which persons of the same age

typically participate are considered



communities

Supports are provided to allow the individual to

interact with typical persons in each setting



naturally occurring


environments

Critical skills are targeted for instruction. When

further supports are needed, naturally occurring

supports are considered first

9. Culturally responsive Cultural activities are included when conducting

an inventory of settings and activities in which

supports may be needed.

Supports take into consideration the culture of

the individual


and quality

Periodic observations are conducted of supports

provision.

Feedback is provided by supervisors.


Summary

In this section we described the process for providing community inclusions services.

These services include both instruction and other supports to allow individuals to

access and participate in activities in their communities. In the next section we discuss

instructional and support strategies that can be used for all community inclusion

services.


SECTION 7: INSTRUCTIONAL STRATEGIES AND SUPPORTS

Introduction

In this section, we first describe procedures for conducting situational assessment in

order to determine the instructional and support needs of the individual in the

employment or community settings. We then describe procedures for planning

instruction and providing supports.

General Description

In both employment and community inclusion services, it is necessary to determine

how the individual will be supported to fully participate in their environments. As we

have discussed previously in this manual, the focus of supports provided in community

settings is on both building independence and accessing other supports to increase

community participation. For this reason, services must include both instruction in

necessary skills and supports to increase participation. Instruction is teaching specific

skills to develop independence. Supports are resources or other strategies that focus on

interdependence to increase participation and inclusion. To determine what instruction

and supports are needed in a community setting, we recommend that you begin by

conducting a situational assessment of the individual in the community setting. This

assessment will assist in identifying both the instruction that will be needed to increase

independence and the other supports that will be needed to increase participation.

In this section, we first describe procedures for situational assessment, then discuss how

to provide instruction and other supports. The organization of this section is shown

below:


How to Implement

A. Situational Assessment

Situational assessments (sometimes called ecological assessments) are used to

determine the specific skills and supports that will be needed for the individual in each

of the targeted settings and activities. These assessments take place in the natural

settings for each activity and focus on assessing actual performance of typical tasks.

B. Instruction

Writing objectives

Teaching using a task analysis (including writing a task analysis, prompting, and

other considerations)

Planning for generalization

Self-directed learning

Collecting and evaluating data

C. Supports

Supports for social and communication needs

Supports for self-determination

Supports for behavioral and sensory issues

A. Situational assessment:

Assess the person in targeted settings and activities to determine:

a) Instruction needed to teach skills for participation in each setting or activity

b) Supports needed for participation in each setting or activity


Situational assessments are a useful first step in planning instruction and supports as

they provide information on the skills and behaviors that the individual already knows

(those that do not need instruction and support) as well as the skills and behaviors that

the individual does not know (those that require instruction or support). Here we

provide guidance on the steps involved in situational assessments.

First, determine where it is important to conduct situational assessments. For

individuals who are receiving employment services, assessments will be needed in

current and future work settings. For individuals who are receiving community

inclusion services, assessments will be needed in all current and future settings that will

be targeted through these services.

Next, in each setting determine what skills, routines, and behaviors are necessary for all

individuals to participate successfully. You can do this by visiting the setting and

observing others participating in the activities of the setting. Make note of:

The skills or tasks that people engage in. For example, in a work setting, what

tasks do the workers carry out? In a recreation setting such as at the gym, what

skills do people perform to participate in the activity?

The routines that are necessary. For example, in a work setting, what routines

are there for checking in with supervisors in the morning? At the gym, what is

the routine for entering the gym and checking out equipment?

The behaviors that others exhibit. For example, in the work setting, how do

coworkers behave with each other? How are they dressed?

Other variables that may affect success, such as physical space, noise, odors, social

climate, interactions with others, physical demands, pace, etc. For example, is the

setting loud or busy? At the gym, do people interact with each other? How do

they interact? In the work setting, do coworkers engage in personal discussions

or do they only discuss work?

Once you have gathered this information, you can begin assessing the individual in

these settings. To do this, you should accompany the individual to the setting and

observe him or her participating in the typical activities. Make note of:

The skills, routines, and behaviors that the person performs independently

The skills, routines, and behaviors that the person required prompting to

perform and the level of prompting required

Other supports that were needed for the person to perform the skills, routines,

and behaviors

The person’s interest in the setting as a whole and in each relevant activity


The variables that may affect the person’s success in the setting, such as physical

space, noise, odors, interactions with others, physical demands, pace , etc.

The supports that are typically available or that could be developed to assist the

person in participating in this setting.

Each setting should be visited a number of times to gain an accurate understanding of

the needs of the individual and the demands of the environment.

Below is an example of a situational assessment form completed for Sally (following on

from the example from section 6).

Situational Assessment Form

Location: Somewhere Community College

Name: Sally

Dates of assessment: February 2010

Activities in this location: Sat in on classes for Digital Photography I for one week

Complete the first column before starting the situational assessments. Visit the setting and

observe typical persons participating in the activities. Use each additional column to record the

level of prompting or support required in each situational assessment.

Key for level of prompting or support required in each assessment: I = independent, G =

gesture, IV = indirect verbal, DV = direct verbal, M = model, PP = partial physical, P = full

physical, IC = instructor completed

Person’s responses in each assessment

Date: 2/1 Date: 2/3 Date: 2/5 Date:

Skills/tasks that people engage in

Being ready for class IC IC IC

Enter class and find a seat I I I

Pay attention in class M M DV

Raise hand to talk G IV IV

Work in group with classmates I I I

Learn skills taught in class M M M

Complete assignments NA DV DV

Routines that people follow

Selecting a class IC IC IC

Registering for class NA NA NA

Submitting homework online NA NA NA

Other behaviors that people exhibit (consider dress, communication, social interaction, voice


level, etc.)

Talk quietly in group work I I I

Talk to others before and after DV I I

Dress casually IC I I

Communicate professionally with

instructor

I I I

Variables that may affect success in

this setting (consider physical space,

noise, odors, social climate,

interactions with others, physical

demands, pace, etc.):

Classroom is small, relatively well-lit

Pace of class activities is quick

Students interact before and after class

Supports that are typically available

to all persons in this setting:

Support for assignments available from instructor

during office hours

Study group set up by some of the other students

Assistance available from Office of Disability Support

Services for test preparation, accommodations

Person’s interest in this setting and

activities:

Highly motivated to participate in class

Loved the hands-on activities and interacting with other

students

Skills/routines/behaviors performed

independently:

Interacting with other students

Entering class and finding a seat

Working in group with classmates

Skills/routines/behaviors that

required prompting: Getting ready for class

Raising hand, paying attention

May need further instruction in photography skills

taught in class

Completing assignments

Other supports needed: Finding a class that fits Sally’s schedule

Registering for class

Buying needed materials

After assessing the person in each setting a number of times, you should summarize for

each setting:


a) Which of these skills, routines, and behaviors the person already performs

independently

b) Which of these skills, routines, and behaviors will require support, either

through instruction or through other methods such as support from persons in

the setting or adaptations to the environment

From this summary, you can identify goals for instruction and begin to plan for

additional supports. For example, a summary of the instructional and other support

needs for Sally is provided in the last two rows of the situational assessment form

above.


Situational assessment form

In the following sections, we provide guidance on planning for both instruction and

supports.

B. Instructional Strategies

Writing Objectives

The first place to begin when planning instruction, is to write an instructional objective

for each skill/goal you plan to teach.

For each selected instructional skill/ goal, an objective (more specific statement) has to

be written. The written objectives have three components:

1. Condition

2. Description of targeted skill/ behavior

3. Criterion

Condition: Describe a set of circumstances under which the targeted skills will be

performed. For example:

When given the verbal direction “Time to start work”<

During lunch break at community college<

After entering the grocery store and using a picture shopping list<

The purpose of this description is to make specific the conditions in which the targeted

skill is expected to occur with and without specific adaptations or supports.

Description of targeted skill: Next, you will identify the learner by name and specify

(using objective terms) what you expect to see.


Bill will be able to complete his work task as defined in the task analysis

Jaime will be able to converse with at least one friend

Daniel will be able to find the items on the shopping list and put them in

the cart

It is important to define the behavior (what you expect to see) in objective measurable

terms because:

1. Different people should be able to observe and recognize the behavior

2. When you collect the data to evaluate change, this will help you to be sure

that the change observed has actually happened

3. If different people will be involved in instruction, they will be sure that they

are teaching the same skill

Ask yourself:

1. Can you count the number of times behavior happened?

2. Can a stranger read your definition and be able to recognize the behavior/

skill when it occurs?

If your answer is “yes” to both questions, then the behavior is objectively defined.

Criterion: This sets the standard for the minimally acceptable performance, such as:

Completing 8 out of 10 steps independently

On 4 out of 5 days

On 90% of opportunities

On each occasion

The purpose of criterion is to define “success” of your instructional strategy. It should

be individualized for each person.

Examples

Putting these three components together gives us the goal. For example:

When given the verbal direction, “Time to start work,” Bill will be able to

complete his work task as defined in the task analysis, completing 8 out of

10 steps independently

During lunch break at community college, Jaime will be able to converse

with at least one friend on 4 out of 5 days in a week.

Teaching using a Task Analysis

Writing a Task Analysis

Once you have identified and written the goals the objectives, the next step is to

consider writing a task analysis. Skills can be discrete or complex. Discrete skills are


distinct and can stand alone, such as word identification and reading, matching labels

to items, counting, eye contact when greeting, or signaling wants and needs. Most skills

for home and community settings are complex. Complex skills, as opposed to discrete

skills, on the other hand, involve a sequence or chain of multiple (smaller) steps or

skills. Complex skills can form routines when the sequence of skills is one that is

performed regularly (such as “arriving at work” or “being prepared for class”).

Examples of complex skills or routines include taking a shower, having a conversation

with a colleague, writing an essay, purchasing in a supermarket, or operating a video

player. The focus of this section is complex skills and routines.

To teach complex skills and routines, you will need to break them down to smaller,

more manageable steps, and teach the learner how to perform them one at a time. A

detailed description of each small step in a complex task or routine is called task

analysis.

To write a task analysis, you first will need to determine the critical steps in the task. To

do this, you might need to perform it yourself or observe others performing the task

using actual materials in the natural setting. While observing or performing the tasks,

note the steps that are involved. Then you will need to validate the task analysis and

incorporate learner preferences and style by having the individual perform the required

steps (i.e., field test the task analysis). The task analysis should be adapted to fit the

individual needs and preferences of the learner (e.g., in terms of supports needed to

perform a skill, people involved, what order to perform steps in). Opportunities for self-

direction and problem-solving can be incorporated throughout.

For example, for the task of grocery shopping for 3 food items using a list, the steps may

be:

1. Enter grocery store

2. Take a basket

3. Take out list

4. Read first item on list

5. Find first item

6. Read second item on list

7. Find second item

8. Read third item on list

9. Find third item

10. Proceed to checkout

11. Place items on belt

12. Pay for items


Learner preferences can guide the order of steps (e.g., whether to take out the list or

take a basket first) and self-direction can be incorporated by allowing the learner to

decide which item to find first.

Tips and Considerations:

1. How detailed should the task analysis be?

This will depend on the learner. Some learners will need instruction on each component

of a task whereas others may be able to follow larger steps. For example, the task of

taking a morning shower may be broken down into the following steps: (a) turning on

water, (b) washing one’s hair, (c) washing one’s body, (d) turning off water, (e) drying,

and (f) brushing one’s teeth. Those simple steps constitute a basic task analysis.

However, for some learners who do not already know how to complete the individual

components of these steps, you may decide to write a more detailed task analysis, in

which, for example, the step of hair washing may be broken down to: (a) massaging hair

with shampoo, (b) rinsing shampoo, (c) applying conditioner, (d) rinsing conditioner, (e)

drying hair with a towel, (f) combing hair.

2. Consider respectful teaching practices, including giving individual your full attention

when teaching, acting as a good model, treating the person with the same respect you

would want for yourself, paying attention to body language of the individual, and

seeking out indications and confirmations of learning.

3. What steps do I teach first and how many do I teach at a time?

You have several options:

a. You may teach one step at a time, beginning with the first step in a sequence

(forward). The remainder of the steps will be completed by the instructor or by

the individual with the instructor’s assistance. When teaching the later steps, the

learner is expected to perform the previous steps with minimal to no assistance.

b. You may teach one step at a time, but beginning with the last step in a sequence

(backward). You will assist the individual in performing the earlier steps or will

complete them for him/ her. The individual is expected to perform the last step(s)

in the chain independently.

c. You may teach all steps simultaneously (the total task), beginning with the first

step in a sequence. Assistance and feedback are provided only on steps for which

the individual needs help.

d. You may teach a few steps at a time (chunking), either beginning with the first

few steps or the last few steps of the task analysis.

The choice of order and number of steps to teach will depend on the learning style of the

individual and the type of task you are teaching. Most tasks should be taught using option C.

However, some learners may find total task instruction frustrating and may benefit from the

other options. Some learners enjoy learning a step at a time or learning the end of the long


chain first so that they can realize outcomes more quickly.

Types of Prompting

Prompting is a form of assistance used to facilitate learning. By providing a prompt, we

encourage the individual to initiate or complete steps in a task.

While prompts are often delivered by instructors, others are “instructor-free”, including

such formats as picture cues, video prompting, and audio-recorded instructions.

Instructor-free prompts allow the individual to perform the task independent of others’

reminders and therefore increase self-determination. These will be discussed in more

detail in the section on self-directed learning.

Instructional prompts (those delivered by an instructor) consist of several types that

may be viewed on a continuum from least to most intrusive (see below):


Prompting systems

Different types of prompts described above may be implemented in isolation, in

combination with one another, or as part of a prompting system.

The goal of all instructor prompts is to first encourage or prompt the learner to initiate a

skill or a step in a task analysis, and then fade the prompt so that the learner

performance the skill or step in the task analysis independently or without instructor

assistance. The following “systems of prompting” provide common ways of fading

instructor prompts.

Systems of Prompting

Three common ways of prompting are:

Independent - no assistance provided

Indirect Verbal- words that tell the person that a response is expected (e.g.

“What’s next”).

Direct Verbal words that tell the person how to respond (e.g., “Wash your

hands”, “Put your red notebook on the math textbook”)

Gestural movements that indicate what you want a person to do (e.g.

expectant facial expression, pointing to the desired direction)

Model movements that demonstrate the targeted skill to the learner

Partial physical prompts minimal physical assistance (e.g., light touching) that is used

to initiate person’s response

Full physical prompts - full physical assistance such as hand over hand). Note: use as

little guidance as possible and never involve force!!

LE

AS

T M

OS

T


1. Constant time Delay. In this method, a prompt (one that the learner will respond to

every time) is provided for each step of the task analysis. This prompt may be a

verbal direction, a model, or physical guidance, but must be a prompt that will cause

the learner to perform the necessary step. In general, once it is time for a step of the

task analysis to be completed the instructor waits for a few seconds (for example, 5

seconds) then provides the prompt. For example, if the task analysis is for

purchasing items from a shopping list, the instructor and the learner enter the store,

at which point, the instructor waits 5 seconds for the learner to initiate the step, then

provides a prompt for the first step of the task analysis if this step is not initiated by

the learner. This prompt could be, “Take out your shopping list,” accompanied by a

model of taking out the list. When the learner performs this step the instructor

provides praise. However, if the learner performs the step incorrectly the instructor

provides the same prompt again until the step is performed. Next the instructor

waits 5 seconds for the learner to initiate the second step, then delivers the prompt,

“Read the first item,” and points to the first item. This procedure would continue for

all the steps of the task analysis.

2. Least-to-Most prompting. In this prompting system, you will gradually increase the

degree of assistance needed for each step, until the learner performs each step of the

task correctly. With least to most prompting, the instructor waits for a few seconds

at each step of the task analysis to see if the learner will initiate the step

independently. If the learner does not begin the step after a short delay, then the

least intrusive prompt is given first (e.g., a gesture). If the learner’s response is

incorrect, then a more intrusive prompt is provided (e.g., indirect verbal prompt),

and so on, until the learner correctly completes the step. For example, Jane’s

instructor decides to use least-to-most prompting to teach the task of setting the

table for dinner. She arranges the prompt hierarchy that will be used (from least to

most intrusive) as: gesture, indirect verbal, direct verbal, model. She decides to wait

for 5 seconds before prompting. When it is time for Jane to set the table for dinner,

she waits 5 seconds to see if Jane will initiate the first step of taking four knives and

four forks out of the kitchen drawer. If Jane independently initiates the first step, the

instructor praises her. If Jane does not respond within 5 seconds or makes a mistake,

the instructor points toward the kitchen drawer. If Jane again does not respond

within 5 seconds or makes a mistake again, the instructor says, “What do you need

to set the table?” Again, if Jane does not initiate the step within 5 seconds, the

instructors says, “Take four knives and four forks out of the drawer.” Finally, if Jane

does not initiate again, a model is provided in which the instructor repeats the direct

verbal prompt and models taking four knives and forks out of the drawer. This


process is followed for each step of the task analysis. Once the learner begins to

learn the steps, less intrusive prompts will be required until they are able to initiate

each step independently.

3. Most-to-Least prompting. This system is the opposite of Least-to-Most prompting.

Here, the highest level of prompting is provided initially for each step, and gradually

decreased moving most to least intrusive prompt as the learner demonstrates the skill.

For example, when teaching Angela to learn the steps of operating a computer, the

instructor might start by prompting Angela to complete the first step using full physical

guidance (i.e., guiding Angela’s hands to turn on the computer). Praise is provided

following completion of this step. Then the next step is prompted using full physical

guidance, and so on. Once Angela can do a particular step with full physical guidance,

the instructor then uses a less intrusive prompt, for example a model. This process is

followed until each step can be completed independently. Most-to-least prompting can

be particularly useful when safety is an issue, for example for teaching street crossing

skills.

Tips and Considerations

When teaching, you will need to make decisions about increasing or decreasing the

amount of prompting needed.

Prompt Fading Error Correction If a learner is doing well with minimal prompting

on your part, it would not be a good idea to

continue prompting as the individual may become

“prompt dependent” or unable to act on his/her

own unless prompted. Remember that the goal of

learning is mastery, independent performance, and

maintenance of the skill. Therefore, at some point

you will have to gradually remove all prompting.

This process is similar to teaching a child to ride a

bicycle first you firmly hold the bike, soon you only

lightly support it, and finally let the child ride it

independently.

Mistakes are a natural part of any learning process.

A natural (and ethical) thing to do in case of an

error would be to increase the amount of assistance

provided. For example, if a learner makes an error

under the indirect verbal prompting, go one level

down and provide the direct verbal prompt.

Commonly, error correction occurs immediately

after an error is noticed. Sometimes, erroneous

responses are gently interrupted even before they

occur with a prompt of a higher level.


Planning for generalization

As noted above, generalization is the most advanced stage of learning, which will

require careful planning from the beginning of instruction process. Think proactively

about the types of skill generalization you want to achieve. Do you want the learner to

use the skill in different settings, times of the day, with different people, materials,

situations? Then include training for generalization in your teaching. Three most

common ways of incorporating generalization when teaching are described next.

1. Use multiple exemplars. For example, when teaching a learner to use an ATM

machine to withdraw money, consider using different types of machines. When

teaching someone to fill out a job application, try to think of the different possible

forms. When teaching someone to zip a jacket, use different jackets with different

zippers.

2. Train loosely. Instead of asking a learner to perform always under the same set

of conditions, try a more natural approach. For example, when teaching a person

to have a “small talk”, ask different people to have a conversation with the

individual. Similarly, train in different settings, during different circumstances,

and at different times of the day.

3. Use a general case method. Identify all the possible variations in the materials

and environmental conditions, and train across those conditions. For example, to

teach a person to use a public restroom, you will identify all possible public

restrooms that the individual is likely to visit (e.g., school, local coffee shop, gas

station), describe the different variations in those settings (e.g., types of locks,

automatic vs. manual flush, types of soap dispensers), and train the person to

appropriately respond to all types of environments.

A matrix like the one below may assist you in incorporating the targeted skill across a

variety of contexts and activities. List all the activities and contexts that the individual is

engaged in throughout the day in the left column; the targeted skills in the first row

(examples are given in the table); then fill out the table by describing the ways in which

any given skill will be performed in as many contexts / activities as possible.


Self-Directed Learning

Instead of always relying on instructor’s prompt to teach, consider teaching the learner

to use “instructor free prompts” to self-direct their own learning. Another term for self-

directed learning is self-management. The primary advantage of using self-directed

prompting is that the learner is provided with a system to cue his or her learning,

reducing dependence on the instructor or others for prompting. Self-management

procedures are sometimes divided into two subgroups according to how prompting is

delivered: (a) externally generated such as pictures, videos, printed materials, and (b)

self-generated by the learner (i.e., self- instruction). In addition, visual prompting

systems may be particularly useful for individuals who cannot remember a complex

Activity Matrix

Name__________________________ Date _____________________

Target Skill / Objective

Activity Skill 1: Greeting coworkers

Skill 2 : Being organized

Skill 3: Working independently

Entering work Greet people in

locker room and

break room

Check in with

supervisor Greet supervisor Have correct

uniform and

work tools

Work tasks Work on assigned tasks

Lunch break Greet people in

break room Have lunch items

Check in with

supervisor Have correct

work tools

Work tasks Work on assigned tasks

Check out Say goodbye to

supervisor

Leave work Say goodbye to

people in locker

room


chain of steps as they remain with them as a permanent reminder. This type of

instruction has many advantages, including encouraging independence and self-

determination, and a lack of intrusiveness compared to instructor-directed procedures.

Self-instruction procedures include visual or auditory prompting, or self-instruction,

evaluation, and reinforcement.

1. Picture cues. In this type of procedure, permanent visual antecedent prompts

(e.g., line drawings, pictures, or photographs) are introduced to prompt the

learner’s response (e.g., complete an activity). We often use visual prompting

strategies in our everyday lives; for example, we create shopping lists and “to-do”

lists, put post-it notes with reminders to ourselves, and so on. Visual prompts can

also be used to teach people with ASD. For example, each of the steps of Paulo’s

task analysis for a job skill of repotting plants was illustrated by a photograph of

the corresponding step in this task. Jack likes to read comics, so a schedule was

created for his morning routine, with each step illustrated using an example of his

preferred comic character and explained on one page. These kinds of visual

prompts are relatively easy to implement and low-cost. Note that your choice of

the mode (i.e., line drawing vs. photographs of real people) should be driven by

your knowledge of the individual and his/ her learning preferences. One common

tool for creating picture cues is Boardmaker ®. This commercially available

software program can be used to generate a variety of pictorial materials as well

as to download existing illustrations from a comprehensive database. Boardmaker

picture symbols may be used to promote self-directed learning, social skills and

communication. It is available for purchase on the publisher’s web site

http://www.mayer-johnson.com.

2. Video prompts. The recent advances in the use technology offer additional ways

to facilitate self-directed learning of individuals with ASD. In video prompting,

an individual watches video clips of himself or a peer model engage in the

desired behavior, and then performs the response. Recent work on video

prompting involves portable video devices such as portable DVD players, laptop

computers, or IPods, which add flexibility to the delivery of instruction. For

example, rather than watching the entire sequence of tasks (e.g., making a salad)

and then performing all the steps, the individual may take the portable video

device to the kitchen, where he/she would watch a video segment depicting one

step in a task (e.g., cut the tomatoes), perform one step at a time, and then move

on to the next step. Video prompting devices offer an additional benefit of

combining visual prompting with auditory cues. For example, Jerry’s video

depicted him performing a job task of cleaning shoes and used audio recording of

http://www.mayer-johnson.com/


his own voice, explaining each step in the task. Several considerations related to

the use of video prompting deserve mention. First, an instructor has to have some

technical expertise as well as possess the necessary equipment to design and

implement this intervention. Second, while the portable equipment is usually

very user-friendly, some individuals will require assistance in operating it, at least

initially. Finally, when designing the intervention, decisions with regard to the

involvement of peers or target individual as models need to be made. Whenever

using peers as models, remember that they need to be similar to the learner in age

and to be of the same gender. An additional possibility is to depict events and

activities from the learner’s vantage point (as if viewed by the individual). Once

again, those decisions should be driven by the knowledge of the individual and

his/ her learning style. Overall, video prompting is an effective, flexible, and low-

cost intervention that many learners find enjoyable.

3. Published hand-held prompting systems. Several prompting systems are available

commercially and may be used on handheld computers (e.g., PDAs or IPods).

Similar to portable video equipment, these devices have the potential to promote

independent learning of individuals with ASD. They are small, portable, socially

acceptable, and may hold a large amount of information (i.e., pictures,

photographs, video and audio files). Some of them may be used with a keyboard,

while others are operated through a touch screen. One of the commercial

programs that may be used on portable digital assistants (PDAs) is Visual

Assistant, available through AbleLink Technologies at

http://www.ablelinktech.com. The Visual Assistant is a multimedia software

program that enables a learner to view step-by-step pictures or videos paired with

auditory instructions. It is particularly useful for assisting individuals in

performing complex multi-step tasks. The prompts are viewed on a portable

device, and the learner may progress at his/her own pace to complete the

sequence by pressing the “Next” function. Instructors may download customized

pictures of the steps (e.g., taken on a digital camera) and record audio instructions

to facilitate learning.

Another software program, the IPrompt ® application for IPhone or IPod Touch

is available for a relatively low-cost download from the iTunes App Store or from

the web site of the publisher http://www.handholdadaptive.com. Similar to

Visual Assistant, this application allows instructors and individuals with ASD to

download the available or custom-made pictures of the steps in activities and

tasks. The application allows users to create captions of the activities, has a choice

function, and a countdown timer; however, it does not include audio prompts or

http://www.ablelinktech.com/

http://www.handholdadaptive.com/


voice output. In addition to its potential to promote learning, the program also

allows instructors and individuals to create visual activity schedules and Social

Stories™.

4. Self-instruction. In self-instruction, a learner provides his/her own prompt,

monitors and evaluates his/ her performance, and delivers reinforcement. To use

self-instruction, three steps must be followed. First, the learner is taught to

verbalize cues to guide their actions and learning. For example, the learner is

taught to say out loud, “First, take the laptop, notebook, and pencils out of the

backpack. Then, put the backpack on the floor.” Second, the learner needs to be

taught to recognize his/ her own behavior, to determine its occurrence or

nonoccurrence, and to record it (e.g., put a plus or minus or a check mark next to

the description of a step on a recording sheet). Finally, the learner needs to know

whether a reward should be earned for performing the behavior. Self-instruction

may be used as a teaching tool as well as a problem solving strategy. For example,

a learner may be taught to (a) state the problem, (b) look for a solution, (c) state

the action and evaluate, and (d) reinforce.

Collecting and evaluating data

Data collection is the process of observing and evaluating the details of teaching and

learning. Before teaching, you will need to decide: (A) what type of data will be

recorded (e.g., correct responses, incorrect responses, prompted responses, level of

prompting), (B) what type of data you will collect (e.g., percentage of correct responses),

(C) how often (e.g., daily, every other day, several times per day), and (D) how those

data will be used (e.g., to make instructional decisions).

After the data are collected, it will be useful to graph them in order to get a better visual

representation of the trends. This can be done either by hand or using computer

software. To draw a trendline by hand, you will first need at least 6 data points. Start

the graph by plotting the days or sessions on the horizontal axis and percentage of steps

independently correct on the vertical axis. Take the median percent correct for the first

three days and draw a point at the intersection of the second day and the median

percent. Then take the median percent correct for the last three days and draw a point

at the intersection of the fifth day and the median percent. The trendline is then drawn

by connecting these two points with a straight line. Alternatively, data can first be

entered into Microsoft Excel, then a trendline can be drawn by selecting “Trendline”

(under the Chart Tools Layout tab in Office 2007).


Regardless of how data are graphed, instructional decisions must be made on a regular

basis. One recommendation is to graph and draw a trendline every six sessions. If there

is a clear increasing trend you can assume that the instruction is effective and no

changes will be needed at this time. If the trend is decreasing, flat, or increasing slowly,

you may want to consider making changes to the instructional approach and consider

the motivation of the individual to learn the task. For further information on making

instructional decisions, readers are referred to Browder (2001) – see reference at the end

of this section.

Below we show an example of how a task analysis form can be used to collect data. We

also show how this data can be graphed using Excel. In this example, we can see that

the instruction appears to be effective as there is an increasing trend in the number of

steps that James is completing independently. Note that the data can also be graphed by

hand using the task analysis data collection table as graph paper.


Example Task Analysis Form

Name: James Date: April 12, 2010

Skill: Purchasing 3 items in grocery store

Mastery: 100% correct for 3/3 consecutive sessions

Coding system:

Instruction: + = independent correct, G=gesture, IV=indirect verbal, DV=direct verbal, M=model

Task analysis Cue Date

4/19 4/21 4/23 4/26 4/28 4/30

Pay for items Cashier says

amount

IV IV G IV G G

Place items on belt In line at

checkout

M DV IV DV IV +

Proceed to

checkout

All items in

basket

DV IV IV IV IV +

Find third item Read third

item

IV + + + IV +

Read third item on

list

Second item in

basket

IV DV G DV G G

Find second item Read second

item

IV + + IV IV +

Read second item

on list

First item in

basket

DV IV IV IV IV IV

Find first item Read first item M IV + IV IV +

Read first item on

list

List and basket

in hand

M IV IV IV IV IV

Take out list Basket in hand DV DV IV DV IV IV

Take a basket Entered store DV IV G IV G G

Enter grocery store “time to go

shopping”

+ + + + + +

% independent correct 8% 25% 33% 17% 8% 50%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

19

-Ap

r

21

-Ap

r

23

-Ap

r

26

-Ap

r

28

-Ap

r

30

-Ap

r

% s

tep

s in

de

pe

nd

en

t co

rre

ct


C. Instructional Supports

In addition to instruction in skills to increase independence, additional supports will be

needed to increase participation in community settings. Supports are resources or other

strategies that focus on interdependence to increase participation and inclusion In this

part of the manual, supports for the unique needs of people with ASD will be described

in three broad areas: (a) supports for social communication, (b) supports for behavior,

and (c) supports for self-determination.

a) Supports for Social Communication

Social interaction and communication are two major areas in which individuals with

ASD may experience difficulties. Social difficulties may be displayed as the following:

Impairment in the use of nonverbal cues such as eye-to-eye gaze, facial and

body language, and gestures to regulate social interactions

Limited peer relationships

Limited emotional reciprocity

In some participants, social difficulties may be accompanied by:

Delay in spoken language

Limited ability to sustain a conversation with others

Stereotyped use of language (e.g., echolalia or repeating one word or phrase)

Limited imitative or make-believe play (in younger individuals)

It is important to note again that these are common difficulties of individuals with ASD

but not all individuals with ASD will experience all of these difficulties. However

difficulties such as these may lead to detrimental long-term outcomes for people with

ASD, including loneliness, a lack of friendships and social support, and depression. As

a result, many individuals with ASD will need additional supports in overcoming the

challenges associated with a lack of social communication skills.

Although social communication difficulties are universal in ASD, each person has

unique strengths and weaknesses. People with ASD, in particular, may have a range of

social and communication abilities. Thus some individuals have strong social

communication skills while others may choose not to use verbal communication, some

individuals are very socially active and motivated to interact while others may be

extremely socially withdrawn. However, with appropriate modifications, the supports

described below may assist many persons.

Priming


This method involves introducing the individual to activities in practice situations prior

to exposure to the actual situations with the intention of increasing the probability of

successful participation in these real-life situations (e.g., Wilde, Koegel, & Koegel, 1992).

When supporting social communication skills, priming involves explaining and

practicing the skills required in a social situation prior to the actual participation.

Previewing of an activity or skill should occur in a relaxed non-demanding manner, to

alleviate any anxiety associated with it.

For example, you may provide an individual with a list of topics that would be

appropriate to discuss with colleagues during a lunch break and practice conversation

of those topics before entering the lunch setting. When supporting an individual in

initiating a greeting, you would explain appropriate ways to greet, including verbal and

nonverbal communication cues, and then role play the greeting skills. Priming may also

be useful in explaining social norms to an individual, such as dress code at work.

Note that this strategy may be used in supporting individuals with ASD in a variety of

other areas, for example, when introducing new activities and routines. It may also be

used in a variety of formats, such as video priming. This strategy is easy to implement,

and may facilitate inclusion of persons with ASD in typical educational settings.

Scripts and Script Fading

Scripts (e.g., Krantz & McClannahan, 1993, 1998) are another simple strategy that may

be used to support social communication. Although they are more widely used to teach

communication skills to young children with ASD, they may also be used effectively as

a support strategy for those adults who have the necessary communication skills in

their repertoire, but are rarely or never using them. This strategy involves providing

individuals with ASD with audiotaped or written words, phrases or sentences, as well

as descriptions of social expectations. They serve as a permanent visual reminder for

people with ASD, similar to visual cues described above, to engage in an appropriate

social exchange with a communicative partner. For example, as making social

initiations may be particularly challenging for persons with ASD, a script to support

initiations may involve providing the person with the following scripted “starter”

phrases, tailored to the specific circumstances and contexts, such as:

“Kate, would you like some chips?”

“Hey, Maria, would you like to take the bus home together?”

“Ms. Jones, I am done for today.”


Scripts may be illustrated by photographs or drawings (e.g., photograph of shoes, chips

etc.) serving as an additional cue to use the skill. As mentioned above, they may be

presented in written or auditory format.

It is important to note that initial training in the use of scripts for communication occurs

one-on-one with an instructor. Scripts may initially be supplemented by the role play

involving instructors and then trained peers if possible. These individuals should be

instructed to use a high level of engagement and enthusiasm when conversing with the

learner, at least initially, and try to make the exchange as natural as possible. To avoid a

lack of spontaneity and mechanical responses, you need to gradually incorporate the

use of scripts in naturalistic settings and practice them with a variety of communicative

partners.

In addition, remember that most scripts need to be gradually faded to promote

independence. Fading is the key component of this method. For example, the initial

scripted statement may be: “Jane, what are you doing”; then gradually faded to: “Jane,

what are you”, followed by “Jane what are”, etc until the script includes quotation

marks only. Other scripts, for example, talking to a job coach about things that

happened at home over the weekend, do not need to be faded as they may only be used

once. The ultimate goal is unprompted spontaneous social communication.

It is also important to keep in mind that some individuals may initially need additional

direct support in the use of scripts (e.g., you may need to use instructional strategies

such as prompting systems to teach the person to touch the scripted statement, face the

peer, and make a statement). Prompting should also be gradually faded so that learners

with ASD become independent in initiating social communication and in using scripts.

You may also use individual’s preferences and interests to make conversations more

motivating for them.

Although this method was initially developed for children with ASD, it may also be

used with adolescents and adults with appropriate considerations. Of particular

importance is that social communication skills that are targeted through scripts should

be age- and context-appropriate. An observation in the individual’s natural

environments prior to teaching may be useful to establish appropriateness. When

working with more advanced learners, you may be able to explain what conversation

topics are appropriate and inappropriate given the specific circumstances, situations,

and people. Additionally, modifications may need to be made to use the scripts in a

way that is unobtrusive and does not stigmatize the person. Appropriate practice and

script fading must be implemented prior to using the new skills in natural


environments. Some individuals may need instruction in the rules of appropriate

nonverbal interaction (e.g., be able to orient themselves facing the peer, maintain

appropriate eye contact, etc.) before practicing in natural settings. In addition, when

complete fading of scripts is not possible, modifications to their format and delivery

method could be made to ensure that they are used in a discrete manner. For example,

McClannahan and Krantz (2005) describe the use of scripts to support peer

communication during lunch, by placing small notes with scripts inside the person’s

lunchbox. Technology may be used creatively to assist individuals. For example, a PDA,

notes application of a smart phone, or text messaging system of a regular cell phone

may be used to remind individuals of the scripted content. With more advanced

learners, a simple small pocket notebook containing a list of topics with several

conversation topics or starters may become a substitute of detailed written scripts.

These may also be gradually faded to just one first letter indicating the topic (e.g., “W”

for weather).

Similar to scripts, comic strips prompt persons with ASD to engage in social

conversations with others; however, they may also explain the meaning of certain social

situations. Comic strips use simple line drawings and, like in comic books, illustrate

what people say and what they may be thinking. In addition, colors may be used to

represent emotions (e.g., red for anger, green for happiness).

Social Stories

A lack of social understanding may be common in many individuals with ASD. Rules of

the social world may be extremely difficult for some to understand, leading to anxiety,

confusion, and a range of difficult behaviors. Social Stories (first described by Gray) are

a tool that may be used to interpret social situations and concepts, thereby leading to

better social understanding and improved functioning in individuals with ASD.

Thanks,

Nicholas! Hey Ann,

nice

shoes!

Nicholas is

super nice!


Social Stories are individualized short stories written for people with ASD by their

parents, friends, or instructors with the goal of sharing the relevant social information.

They explain difficult social situations, concepts, or skills in simple and objective terms.

Similar to priming, Social Stories provide a detailed description of a social situation to

individuals with ASD before the actual exposure. It is important to remember that the

primary goal of Social Stories is to describe and explain, not to modify behavior.

Therefore, it is recommended that Social Stories contain a higher proportion of

“descriptive” sentences (i.e., sentences that inform and describe) than “directive”

sentences (i.e., sentences that tell a person what to do). As any story, Social Stories have

a title, introduction, main part, and conclusion. They are written in the first-person or

third-person perspective (as if the target individual was narrating, or in a form of a

newspaper article). At the end, a set of comprehension questions may be asked to check

understanding. Throughout, the story must be written in an age-appropriate manner.

A hypothetical Social Story is presented below.

The following important consideration should be kept in mind when programming the

supports for social communication skills of individuals with ASD: social environments

must support these skills. In other words, the environment should be organized in a

way that promotes successful use of social communication skills. Earlier we talked

about planning for generalization. It may be especially important and challenging when

supporting social communication skills, as they constitute a primary area of difficulty in

ASD. Therefore, it is important that social communication skills that are practiced in

separate settings are ultimately practiced in natural environments and settings, and

with people commonly encountered in those settings.

Looking and Smiling My name is Daniel. I work part-time at a local thrift store. My colleagues are Jane, Lisa,

and Jason. My supervisor is called Robert Jones. When I come to work in the morning, people

typically greet me. They may say, “Hi Daniel, how are you?” I usually respond by saying hello to

them. This is a good idea. I may also say “I am fine, how are you?” When talking to people, it is

important to look at their face. I may look at their eyes, or other part of their face when talking. If I

look at peoples’ faces when talking to them, they will know I am listening. It is also a good idea to

smile when greeting people. This way they will know that I am a nice and friendly person. I will

try to look at peoples’ faces and smile when greeting.

Comprehension questions: (1) what do people typically say when I come to work in the

morning? (2) what should I try to say in response? (3) what should I do to show people that I am

listening when greeting? (4) what should I do to show people that I am nice and friendly?


b) Behavior Supports

Some individuals with ASD may display behavioral challenges which may interfere

with their social inclusion and participation. Behavior supports can help prevent

behavior challenges and help individuals to cope with difficulties. Behavioral

challenges may arise due to:

Difficulties adapting to change or preoccupation with sameness

Lack of coping or social skills for handling difficult situations

Sensory issues

In response to these issues, some individuals may engage in challenging behaviors in

relation to specific situations or contexts. These behaviors may include property

destruction, physical aggression, self-injury, or stereotypical motor movements such as

rocking and hand flapping. Sensory issues may be unique to ASD and warrant a

specific consideration. For example, some individuals may be particularly sensitive to

certain types of noise or visual stimulations, resist wearing certain types of fabric, or

prefer to eat only food of a certain consistence. Needless to say, all of these behaviors

can create significant barriers for the learning and well-being of individuals with ASD

and may lead to increased stress for the people around them. If this is the case, a

behavior support plan should be developed to specify strategies for preventing problem

behaviors, teaching alternative behaviors, and responding to both problem and desired

behaviors. Below we discuss the process for figuring out why behaviors are occurring

and some strategies that you may be asked to implement when working with

individuals with ASD.

Functional Behavioral Assessment

When an individual is engaging in challenging behavior that affects his or her inclusion

in community settings, it is useful to conduct a functional behavioral assessment (FBA)

to figure out why the behaviors are occurring before deciding how to deal with the

challenging behaviors. Through FBA, we examine the effects of the environment on

behavior and consider the function of the behavior for the individual in each situation. I

general challenging behaviors serve one of two functions: to get something or to avoid

something. A number of methods are used to determine what happens before the

behavior (antecedents), when the behavior is more likely to occur (setting events), and

what happens after the behavior (consequences). At the end of the FBA we are able to

state when and why the behavior is occurring. For example, “When working in the

mailroom, James hits the wall and yells loudly in order to escape the job task.” FBA

should also include consideration of quality of life issues. For example, James becomes


frustrated in the mailroom because he does not enjoy his job. A FBA must be conducted

before developing a support plan as strategies that address the function and the specific

environmental triggers of the behavior will be more effective than strategies chosen for

other reasons. For more information on the FBA process, see the resources at the end of

this section.

As part of team supporting an individual who is engaging in challenging behaviors,

you may be asked to collect data or provide information as part of a FBA. An important

aspect of the process of assessing behavior, developing a support plan, and assessing

whether the support plan is working is that all decisions are made based on data. For

this reason, you will most likely be asked to collect data of the behaviors that you see

when you are working with the individual. Another important aspect is that the process

of identifying behaviors of concern, investigating environmental effects and function of

behavior, and developing support plans is a team process. For this reason, the person

conducting the FBA may ask to interview you to get your perspective on the

individual’s strengths and weaknesses, quality of life, and the challenging behaviors.

Behavior Support Plans

Once the FBA is complete and the team has agreed on the reasons behind the behavior,

a behavior support plan will be developed. A good behavior support plan will include

several types of intervention: a) strategies to prevent the behavior from occurring by

changing the environment, b) strategies to teach appropriate behavior or coping skills,

c) strategies to respond to both challenging and appropriate behavior, and d) strategies

to improve the individual’s quality of life. Some of the most useful strategies you can

implement to prevent challenging behaviors and support positive behaviors of

individuals with ASD are described next.

1. Change the environment to promote success.

Perhaps the best strategy in supporting individuals who engage in challenging

behaviors is to change the environment to prevent challenging behaviors from

occurring. Be aware that sometimes this may include changing your own behavior.

Some common strategies that you may be asked to implement as part of a behavior

support plan are:

Alter the length of task or mode of presentation/ completion. When problem behavior

occurs as a way to escape tasks that are too difficult you may want to change the task to

make it less difficult. You may try to (a) break a complex task down to simpler smaller


components, (b) rather than presenting the entire task in one go, present smaller chunks

of information at a time, or (c) present tasks in a different way, such as via computer,

audio or video equipment.

Incorporate the person’s interests in the task to increase motivation. At times,

individuals may engage in challenging behaviors simply because they find an activity

or task boring. In these situations, motivation may be increased by including the

person’s interests in the task. For example, if James begins to hit the wall in the

mailroom because he finds the job task of sorting mail uninteresting, his motivation

may be increased if he works with a particular person he enjoys spending time with.

Make things more predictable. Some individuals, especially those who are using

challenging behavior to escape certain tasks or to gain access to more preferred

activities or items, may benefit from increased predictability. This may be accomplished

by providing a visual schedule for the day or week, or through increasing verbal

reassurance.

2. Provide more frequent access to what the individual needs or wants.

Provide more attention before the behavior occurs. If an individual engages in

challenging behaviors to obtain attention of other people, it may be useful to provide

more attention before the behavior occurs to eliminate the need for challenging

behavior. You will need to first figure out what type of attention and whose attention

the individual desires, then develop a schedule for providing more of this attention

(e.g., every 10 minutes). Attention should then be provided at the end of each

scheduled period (e.g., come up to the individual and ask how she/ he is doing). If

attention of other individuals (coworkers, family members) is desired, you could try to

arrange for those individuals to talk to the individual at the end of each scheduled

period. For example, James often engages in challenging behavior because he knows

that he will get to spend time with his supervisor. In this situation, the employment

specialist could arrange for the supervisor to check in with James every half hour and to

schedule lunch with James once a week. This way, James knows that he will be able to

spend time with his supervisor without needing to engage in the challenging behavior.

Teach individual alternative appropriate ways of achieving what the individual wants.

Challenging behaviors may become particularly severe when the individual does not

have the necessary communication skills to make his or her needs known. For example,

an individual may be tired, but having no verbal skills to request a break, produces a

high-pitched scream. Following that, he may be removed from the tiring situation,


which supports his screaming behavior in the future. If we teach this person to show a

“break” card to request rest, his screaming behavior will hopefully be reduced and

eventually disappear.

3. If needed, provide crisis management

If despite your best efforts the individual still engages in challenging behavior, it is

important to be prepared by having a clear crisis management plan. A crisis

management plan specifies how to respond when a situation has become dangerous for

the individual or for others in the environment. Note that crisis management is not

needed every time the behaviors occur, just when the situation has become unsafe.

Crisis management is a temporary solution in these situations and should not be relied

upon as the sole strategy for behavior support (strategies to prevent problem behaviors

and teach appropriate behaviors must be emphasized). This plan is particularly

important in community settings where it will be necessary to defuse problem

situations to avoid stigmatizing the individual.

A crisis management plan must be individualized and should have several components:

a) Definition of a crisis for this individual

b) Procedures to follow for responding immediately to the crisis situation

c) Procedures for notifying relevant persons that a crisis occurred

d) Procedures for meeting with the behavior support team to discuss why the crisis

situation occurred and how it can be prevented in the future.

In order to decide whether a crisis management plan is needed, consider whether the

behavior is likely to have substantial detrimental consequences, such as physical injury,

property damage, or rejection of the individual by persons in the setting. If the answer

is yes, then a crisis management plan is needed.


c) Supports for Self Determination

Although many definitions of self-determination exist, self-determination basically

refers to the extent to which people are in control of their own lives. Self-determined

people know what they want and know the ways to achieve what they want. As

discussed earlier, unfortunately, people with disabilities, including ASD, are often

deprived of control over their lives. Therefore, one of your important tasks when

working with individuals with ASD will be supporting their self-determination. This

may be done in some of the following ways.

Provide opportunities for choice

Providing choice may be a powerful tool for enhancing independence, self-

determination, and quality of life. Unfortunately all too often people with disabilities,

including individuals with ASD are deprived of this opportunity, as other people make

decisions for them (e.g., what to wear, where and when to go, what to do). Providing

choice is important for people to feel independent and in control. Choice often results in

improved learning and behavior. Choice may be embedded in any instructional

procedures (e.g. , what activity to do first), daily activities, and decisions (e.g., what to

wear, where to go). It may be provided within an activity or between several activities.

It may also be provided with regard to when to begin or end the activity, who to do it

with, and where. Opportunities for choice also should be provided in important life

decisions (e.g., where to work, where to live, who to be friends with).

Questions to be Asked When Developing a Crisis Management Plan

What crisis management procedures will de-escalate the behavior?

What level of disruption will those procedures cause?

How will you know that the plan should be activated (what are the precursor behaviors)?

Will intervention help to avoid serious injury or damage?

How many people will be involved?

How will staff be notified?

How will you know that the behavior has ended?

How can you be sure that dangerous behavior is over?

How will be student return to the ongoing activity? What supports are needed?

How will you document the crisis procedures?

(adapted from Bambara & Kern, 2005)


For example, during lunch preparation at home, Samuel is offered a choice of activities

(e.g., toast the bread, chop the tomatoes, or warm the soup). Then he may be offered a

choice of places to eat lunch (inside or outside, kitchen or dining room). Finally, he is

offered a choice of meals - salad, soup, or sandwich.

When giving opportunities for choice, it is important to remember and respect the

choices of an individual not to participate in an activity. This may be an indication that

the activity needs to be modified to increase motivation (e.g., by incorporating the

individual’s special interests

Increase environmental predictability.

Some people with ASD may become distressed and engage in challenging behaviors in

response to a lack of predictability of events, settings, or activities. To increase

predictability, you may do several things, such as: (a) set the timer to signal beginning

and end of activity, (b) provide an individual with a clear detailed schedule of activities

for the day, (c) providing advanced auditory or visual notice of change, (d) providing a

clear cue signaling activity change, (e) in case when novel activities are anticipated,

priming the individual on the nature of activities.

Use activity schedules

Sometimes, several visual cues may be combined to form an activity schedule. Activity

schedules consist of a set of pictures and/ or words that serve as a prompt for an

individual to perform an activity / sequence of activities. Similar to using picture cues

for self-instruction, activity schedules are an effective tool to promote self-

determination as a person may refer to them without needing others to tell them the

activities that are on the schedule for the day or week. Choice of activities or order of

activities may be embedded through the activity schedules. In addition, activity

schedules increase predictability and alleviate anxiety associated with unpredictable

hectic environments. While schedules are commonly a visual tool, auditory schedules

may also be created (e.g., via an audio recording).

An activity schedule may show the steps in a particular activity or the activities that

will take place during a specified time period, such as for a particular day or week.

Longer term activity schedules that show scheduled activities for a particular month

may be useful for providing reassurance to an individual when a preferred activity will

occur next. As individuals are often supported by a number of support staff, it can be

useful to show the staff schedule on an activity schedule in order to provide additional


reassurance and independence to the individual. An example of an activity schedule for

the steps that need to be followed for getting ready for work might be:

A useful book that provides detailed instructions on how to create activity schedules is

“Activity schedules for children with autism: Teaching independent behavior” by

McClannahan and Krantz (2010).

Self-management

Self-management is a broad term used to refer to activities carried out by an individual

with the goal of changing or maintaining his or her own behavior. Self-management

strategies include self-goal setting, self-instruction, self-monitoring, self-evaluation, and

self-reinforcement. Self-scheduling and choice-making may also be viewed as self-

management strategies, in the broad sense. Several of them, such as self-instruction and

self-scheduling were described earlier in this section. This part will describe additional

self-management techniques that individuals with ASD benefit from.

A general process of teaching self-management involves several steps: (a) select the

goal; (b) develop the program, (c) teach, model, and practice with the learner; and (d)

implement. We shall go over each of these in some detail.

1. Goal setting. The first step involves identifying and defining the targeted

responses. A range of behaviors may be selected, from easily observable (e.g.,

raising hand to ask for assistance, completing an assignment) to internalized

(e.g., thinking about a topic of restricted interest). You may use several simple

rules to guide goal selection:

Select the goals that fit the learner’s current needs and level of skill

development. For example, monitoring of thoughts may require a higher

level of self-awareness and cognitive development.

Wake Up Eat Breakfast Brush Teeth Get Dressed Catch Bus


As it would be unreasonable to teach self-monitoring of skills that are not

currently in the learner’s repertoire, determine whether he/she has the skills

required to successfully complete the activity.

Phrase goals in positive and objective terms, easily understandable by

learners (e.g. raise hand to ask for help rather than screaming)

Select targets that are meaningful for learners. Initially, you may need to meet

with the individual to explain the meaning of the goal, the importance of self-

management procedures. If applicable, also explain the reward or incentive

system that will supplement the use of the strategy.

Involve the learner in setting his/her own goals and criteria for their

performance (e.g., work on essay for 15 minutes, fold 20 sheet sets)

2. Develop the program.

Determine the procedures for self-monitoring, evaluation, and reinforcement

(the components of self-management procedures).

o Self monitoring involves the individual observing his/her own behavior

and recording whether it occurred. For example, learners may monitor

their own on-task behavior by putting a circle around “yes” or “no”

every five minutes.

o Self-evaluation involves comparing the behavior with a pre-determined

standard. For example, individuals may be taking data on the number of

times they initiated a conversation with a peer during the day and then

evaluating their performance against a criterion (e.g., five times per day).

o Finally, in self-reinforcement learners reinforce themselves after the

targeted behavior occurred. For example, a learner may watch TV for 3

minutes contingent on work performance, verbally reinforce him/herself

for successful problem-solving, etc. Self-reinforcement may only be used

as part of self-monitoring or self-evaluation.

Select a self-monitoring method. Most often, self-management procedures are

implemented using just a pencil and paper. For example, individuals may

check occurrence of eye contact on a prepared self-monitoring form. Consider

putting the definition of a targeted response at the top of the form. If the

targeted goal involves several steps, list each of the steps and use the checklist

form. When developing forms for self-management, one should take into

account the learners’ skill level (e.g., learners with limited reading skills may

not benefit from forms using many written statements), as well as age-

appropriateness (e.g., the use of smiley faces on forms may work with

younger students, but may be stigmatizing for young adults). As a rule of

thumb, the most effective forms are those that are simple and clear.


Establish the schedule. It is important to determine how often the individual

will monitor his/ her behavior. Commonly, behavior is checked once at the

end of a pre-specified time interval. The length of the interval will be

determined by the nature of behavior and its frequency. For example, when

fighting a habit of smoking, an individual may count a total number of

cigarettes smoked at the end of the day or at the end of each hour. Another

option, useful for continuous behavior, may be to monitor its occurrence at

variable rather than constant intervals (e.g., use a vibrating watch to prompt

the individual to monitor attending to a professor in class).

Determine the cueing system. Many options are available to prompt the

individual to engage in self-monitoring, including vibrating watches,

prerecorded tapes with a tone, kitchen timers, or alarm clocks.

3. Teach, model, practice. While many learners may be quick in mastering the self-

management procedures, others will require a more extensive practice.

Specifically, you may meet with the individual, explain the behavior and the

procedures, and initially demonstrate the use of self-management strategies

while the learner observes. You may also consider using a role play – ask the

person to engage in targeted behaviors and then assist him/her in completing the

self-management strategies (e.g., self-monitoring). Finally, have the individual

self-monitor, and provide performance feedback, as necessary.

4. Implement. Finally, self-management procedures are implemented by the learner

independently. You may decide, at least initially, to check their accuracy by

monitoring their performance while they self-monitor. At the end of a self-

monitoring period, you may meet and discuss whether the goals were met, and

problem solve if needed. As individuals are reaching mastery of the targeted

behaviors, you may gradually modify the criterion for performance or increase

the length of self-monitoring intervals

Self-management strategies have demonstrated effectiveness in a variety of

applications. They may be used to improve on-task behaviors, academic or work skills,

social and communication skills, and to decrease challenging behaviors. They may also

be used for independent problem-solving in a variety of settings. For example, in the

context of daily living skills, the application of self-evaluation for problem-solving may

look like this: (a) state the problem: “Light does not go on”, (b) state the response/

solution: “Check if the bulb is broken; if yes, replace”, (c) self-evaluate: “Replaced; now

the light is working”, (d) self-reinforce: “I did it. Great!” Learners may also be taught to

consider several alternatives as solution to the problem and then choose one solution.


Summary

In this section we described how to conduct a situational assessment and how to

provide instruction and supports in community settings. In the following section we

discuss operational issues that you will need to consider when developing community

inclusion services.


Task analysis data collection

Resources:

Instructional strategies:

1. Browder, D. M. Curriculum and assessment for students with moderate and

severe disabilities. New York, NY: Guilford Press.

Using technology:

1. Boardmaker: http://www.mayer-johnson.com.

2. AbleLink Technologies: http://www.ablelinktech.com.

3. IPrompt: http://www.handholdadaptive.com

Positive behavior support:

1. Bambara, L. M., & Kern, L. (2005). Individualized supports for students with

problem behaviors: Designing positive behavior support plans. New York, NY:

Guilford Press.

2. Bambara, L. M., & Knoster, T. P. (2009). Designing positive behavior support

plans. Washington, DC: American Association on Intellectual and

Developmental Disabilities.

Scripts

1. McClannahan, L. E., & Krantz, P. (2010). Activity schedules for children with

autism: Teaching independent behavior. Bethesda, MD: Woodbine House.

Social stories

1. Gray, C.A. (2000). The new Social Story book. Arlington, TX: Future Horizons.

2. Gray, C. (2004). Social Stories 10.0: The new defining criteria. Jenison Autism

Journal, 15, 1-21

http://www.mayer-johnson.com/

http://www.ablelinktech.com/

http://www.handholdadaptive.com/


SECTION 8: OPERATIONAL ISSUES

Introduction

Starting a program for adults with ASD is a groundbreaking area due to the lack of

published research or manuals on the topic. This can be daunting from an operational

standpoint, because of the many different considerations required to begin and

maintain a quality program, including staffing, transportation, resources, billing,

program marketing, and scheduling. The following are summaries and suggestions

from the Devereux Community Adult Autism Partnership Program (CAAPP)

concerning these topics.

Staffing

An integral part of any program is finding excellent staff members to deliver services.

In order to achieve this, there are few areas of consideration: State regulations, Roles

and Responsibilities, Core Competencies, Staff Training, and Supervision. These areas

are discussed in greater detail below:

State Regulations

Oftentimes, there is a mismatch between the qualifications that many professionals

believe are necessary to serve individuals with ASD, what state regulations dictate, and

what reimbursement rates allow for. For example, state regulations often suggest that

direct support staff members should have a minimum of a high school diploma,

whereas many professionals believe that direct support staff should have a bachelor’s

degree. If all consumers are paying privately, a program may opt to have more

qualified staff members than regulations dictate, and rates will likely reflect this.

However, when a program is sustained through public funding, funding levels and

funder requirements for staff qualifications will likely be the decisive factor when

determining staff competencies. Additionally, a program that accepts multiple types of

state funding/waivers, will likely find it more efficient to develop staffing qualifications

that match the requirements of the most stringent waiver. This will not only ensure

better service delivery, but will also allow staff to rotate between consumers regardless

of the waiver.

Roles and Responsibilities

Although each program will differ in regard to its staffing needs, there are some roles

that will be common to many programs and should be considered when starting a new

program. As a program grows and develops, a clinical team would likely need to be


assembled to address the many individualized needs of adults with ASD, however, in

the beginning these duties can be shared by more experienced staff. The following are

examples of the types of staff that will typically be needed.

o Community Based Support (CBS) Staff – Also referred to as direct support or

direct care staff. This level of staff provides employment related and

community-based direct support. Experience with ASD is preferred for this

staffing level, but not always required. However, CBS Staff should have some

experience with people with disabilities. Individuals who are patient with

consumers, aware of the local community, safe in public settings, and

responsible for themselves and others will likely be successful in this position.

Minimum education requirements are often dictated by state regulations and

typically include a high school diploma and possibly a bachelor’s degree.

Staffing ratio for this position is often dictated by the funding source based on

consumer need and likely will be one consumer to one staff.

o Program Specialists – These positions are typically bachelor’s level people who

assist with initial intake of consumers, (re)assessments, goal development,

supervision, collecting and analyzing data probes, and progress monitoring.

Experience with ASD is highly preferred for this position, along with excellent

communication and familial relationship development skills.

o Clinical/Behavioral Support – This position can initially be fulfilled with a

qualified program specialist or clinical director, however, as growth of the

program continues, a separate position should be created to meet the needs of

the consumers. This staff person should hold at least a masters degree in

psychology or a related field, and a strong background in applied behavior

analysis and ASD. This person should be skilled in conducting functional

behavior assessments and analyses, developing positive behavior support

plans, and maintaining the clinical integrity of the program.

o Program Director – The program director oversees the entire program, handles

administrative duties, develops clinical and research opportunities, and assists

with consumer and family issues as needed. This person should have a strong

background in both clinical and administrative work. Typically this person has

a Masters or PhD in psychology, special education, or a closely related field.

Core Competencies and Staff Training


In order to assist staff members with delivering exceptional service, core competencies

should be developed and maintained as basis for staff training. The following are

considerations for areas of core competency development:

o CORE training skills - These competencies are typically mandated by the

funding agency or the provider and can include CPR, First Aid, Suicide

Prevention, Preventing Sexual Incidents, HIPAA, Documentation, and Positive

Approaches.

o Basic ABA Applications and Instructional Techniques – This should include an

overview of strategies related to prompting, visual supports, data collection,

assessment, generalization and social skill instruction.

o Building consumer and family relationships – This can be extremely important

for staff persons who are working with consumers and families in their homes.

Based on these competencies, staff training can be developed for new employees and

for existing employees on an ongoing basis. These trainings can be presented by the

provider, or many other trainings can be found at local conferences or online through

the Bureau of Autism Services Training Site (http://bastraining.tiu11.org/). On average

staff should have about 40 hours per year of trainings, including training in natural

settings, such as the consumer’s home, place of employment or community, to ensure

that staff knowledge has generalized from the classroom to the community.

Supervision

Once staff persons are trained and working with consumers, it is important to continue

to monitor their performance on at least a weekly basis. This can be accomplished by

observing each staff person working with consumers for an hour and discussing areas

of proficiency and areas of improvement. Also, checking-in with each consumer on a

weekly basis to determine if they are satisfied with services and staff is extremely

important. This time can also be used for brief assessments and probes for new goal

development.

Additionally, performing staff evaluations approximately once per quarter based on

program specific performance checklists is important to give feedback, especially to

program specialist staff who may not have weekly supervision opportunities.

Problem Solving

Even the best programs encounter obstacles with individual consumer situations.

Many potential conflicts can be avoided by creating inclusion criteria and a family

http://bastraining.tiu11.org/


action plan for review when consumers begin a program. This allows consumers and

their families to see the program expectations before enrolling. However, if a problem

does arise with a consumer and family, it is important to remember to value all

stakeholders’ opinions, while still providing professional recommendations. Having

the program director address problems and issues from the top can be very valuable.

Additionally, having waiver supports coordinators become involved is helpful.

Supports coordinators can assist balancing family requests with available services.

Transportation

An important part of any community-based program is transportation of staff and

consumers to various individual and group activities and employment. Family

members or friends may not be available to provide transportation for the individual.

Furthermore, transportation from family or friends may not be a desirable option to

foster future independence. Therefore, it is vital for a program to determine how travel

will be addressed to increase future independence. Some waiver programs may pay for

transportation passes, tokens, taxi services, and paratransit services. A consumer’s

supports coordinator will have information regarding funding of transportation

services. Depending on the location of the program office, consumer residences, and

activities, there may be a few options:

Traditional Public Transportation

Public transportation may ideal for many consumers if the program service is located

where public transportation is available. Typically, for those seeking independence,

public transportation will require extensive travel training which can sometimes be

conducted with the regional public transportation service, and should include safety

issues, basic navigation, purchasing tokens/passes, asking for help, entering/exiting the

bus and appropriate social skills for transit.

Paratransit Travel

Paratransit is offered in many areas, especially more suburban and rural areas where

bus service may not be available. Typically, paratransit services are available to persons

with disabilities and elderly people at a discount and include door to door service.

Transportation is usually by shuttle bus, which is less crowded and typically more user

friendly than traditional public transportation. A check of the county’s website often

lists the paratransit options; if not, check with the consumer’s supports coordinator. It

is a good idea for any program personnel to meet with the company running the

paratransit services in order to explain the needs of this particular population and also

bridge a connection between both agencies. Because transportation is so crucial, having


a good working relationship with the provider can be important, especially if there is an

emergency. Often by calling the local paratransit provider, arrangements can be made

for the consumer to initially travel with an escort free of charge. This allows staff

members to ride along with the consumer to learn safety issues associated with travel,

but also entering/exiting the bus, waiting while other consumers are picked up, and

eventually calling to schedule rides. As paratransit is a smaller, door-to-door service, it

often requires less travel training than traditional public transportation, however, this

will depend on each individual consumer.

Driving

Some consumers with ASD can learn to drive vehicles on a full or limited basis. A

proper evaluation is crucial to determining an individual’s driving potential. These

evaluations should be done by trained professionals and are often part of an Adaptive

Driving Program. These types of programs are often available at Rehabilitative

Hospitals. One program to review is the Bryn Mawr Rehabilitation Hospital Driver

Rehabilitation Program

(http://www.mainlinehealth.org/oth/Page.asp?PageID=OTH001113). One-on-one

courses are often recommended following the evaluation. These evaluations and

courses can sometimes be funded through the Office of Vocational Rehabilitation as

part of a future employment goal.

Program/Staff Vehicles

If public methods are not available or appropriate, consumers may be transported in

vehicles maintained by the program or by the staff themselves. This may require special

permissions slips and a legal professional should be consulted for this. Keep in mind

that this method may not be the most desirable for those seeking independence, as it

limits opportunities to learn skills for independence. However, many times this method

is used out of necessity.

Informal options

Some other options that can be considered for transportation may include carpooling

with other employees or paying for transportation to get to preferred community

locations.

Resources needed

Beyond exceptional staff and transportation, there are some basic resources that are

important to consider when developing a program to serve adults with ASD. Many

programs that are just starting up will have limited budgets, so it may be advantageous

http://www.mainlinehealth.org/oth/Page.asp?PageID=OTH001113).%20%20


for startup programs to seek donations of some of the items from businesses who may

be moving, downsizing, or going out of business.

Office Space

Surprisingly, a truly community based program does not require very much physical

space at all. Because learning environments are places of employment, local

communities, and consumer’s homes, a small administrative program office is often all

that is necessary. This space is used for initial interviews, family meetings, staff

training, staff office areas, and behavioral support. In addition to an office area, a small

kitchen is desirable. We have found that professionals and parents may request an area

that is lounge-like for consumers to meet up and enjoy socializing with one another.

This space may have a television, games, or other activities that can be shared.

Vehicles

As mentioned above, some larger vehicles maintained by the program are a valuable

resource for transporting consumers and staff when other forms of transportation are

not available or appropriate to the person’s needs. .

Computers

Having multiple computers is important for not only staff, but also consumer use.

Especially for those consumers who don’t have a computer in the home, computers can

be important for resume building, job finding, internet safety, social networking, trip

planning, online shopping, transportation planning and general internet information. If

computers are not available, local libraries offer the use of computers; however, these

are often limited in both number and the amount of time for which they can be used.

Office Supplies/Furniture

Basic office supplies and furniture for any startup office are necessary. Be sure to

purchase a locking filing cabinet for confidential documents. Also, binders are very

important for collecting consumer data and organizing consumer information.

Communication binders can be kept at a safe place in the consumer’s home to allow

multiple staff to communicate with one another and consumers and families.

Billing

An important part to sustain any program will be funding sources. As discussed in

previous sections, these funding sources are often state waiver programs. When

accepting a new funding source, it will be important for a program to understand how

rates are set, negotiated, and reimbursed. When a budget is developed for a program, it


must first and foremost meet the needs of the consumers and staff, but also fall within

the parameters of reimbursement. Sometimes this occurs with the existing rates;

however, rates can sometimes be renegotiated with the funding source. For rates that

are set and the same for all providers (i.e., Adult Autism Waiver), this is not an option.

For other waivers (i.e., OBRA waiver or Consolidated waiver), each provider can

submit a budget and rate request to the state agency for review and negotiation (Note

that this may change and negotiation may not be an option). Because of this, it is

important to keep accurate records throughout the year, including data on consumer

progress and expenditures to justify the request. Additionally, hours of service for each

consumer should be tracked using billing slips signed by the consumer or consumer’s

guardian. The billing slips should be carbon copies so each consumer receives a receipt

of service and the slips can easily be entered and electronically submitted through the

appropriate reimbursement system.

Program Marketing

When developing a new program, marketing will be important to disseminate

information not only to potential consumers and their families, but also to other

agencies, providers and funding agencies. The program director should make contact

with area supports coordinators and schedule personal meetings, if possible, to discuss

the program, its strengths, and why it differs from other regional programs.

Additionally, posting on local listserves is a great way to let others know about your

program. After the program is running for a few months, having an open house to

showcase your office space and introduce your program is worthwhile. This allows the

local community, other providers, interested families and funding agencies to meet the

staff and consumers and see the program components.

In order to assist with marketing, developing a variety of marketing resources can be

very helpful. Create a long pamphlet of information containing the program mission

and model, program objectives and components, inclusion or admission criteria (if

applicable), and a program application. In addition to this, develop a one page PDF

that can be emailed or easily printed and copied for distribution to mass audiences.

This should just include the main program information, brief objectives and contact

information. If it is in the budget to have a professional marketing agency develop a tri-

fold brochure to showcase the program, this would be a good investment.

Additionally, a website may also be advantageous to make potential stakeholders

aware of the program and services available.

Scheduling


Developing and managing a schedule can be a daunting process for any supervisor.

However, it is important that schedules are coordinated and that staff, consumers,

families, and any other necessary supports agencies are informed regarding the hours

and activities in which you will be supporting the individual. Depending on your

staffing situation and consumer ability, some staff can individually schedule with the

consumer and their families and report the schedule back to the supervisor and other

necessary persons. For other situations, it will be important that at least one person in

the office is aware of all scheduling needs for each consumer and reports this on a

weekly basis to everyone. Some individual schedules will not vary much from week to

week; however, other consumers may have changes in work, new appointments, or

special community activities that require changes in the schedule. As each program is

individualized, this can lead to even more schedule changes. A master schedule can

easily be kept on Excel for each consumer for each day of the week. Special activities

can be noted under each day, along with notes and the whereabouts of key staff

members and behavioral support. This way, at any point in time throughout the week,

all staff should be aware of the whereabouts of other consumers and staff.

Staff Ratios

Staffing ratios for direct support staff are typically dictated by waiver regulations.

Additionally, it is important to look at what ratios work best for the individual

consumer. For many services and consumers, a one-to-one staff ratio works best to

accomplish consumer goals. When consumers are working on group goals and social

skill building, a one to one ratio should be maintained according to the consumer goals

and Individual Support Plan.

Other employees, such as program specialists, should maintain a ratio that allows them

to address consumer needs and provide appropriate supervision of staff. There isn’t

necessarily an ideal number for consumers to program specialists, but instead this

should be determined by the number of hours each consumer is approved for, the

complexity of the issues and needs, the travel time to visit the consumer, and the

number of other staff supervising the consumer.

Substitutes

It is inevitable that any program will face a staff shortage at one point or another. This

can be temporary when a staff is sick for a day or two, or it can be more long term if a

staff person leaves. We encourage you to hire support staff who are then trained to

work with a number of consumers so that staff with whom a consumer is unfamiliar are


not asked to provide support. This proactive approach can help to avoid a number of

problems with staff shortages. A program specialist can sometimes fill a temporary staff

vacancy, and this time can be very useful to update assessments, probe new consumer

skills, and update information. Also, other direct support staff who know a consumer

through social skills groups may be interested in adding a few more hours of work with

a consumer. It is important that the consumer is in agreement if a substitute staff needs

to be used. Additionally, it is a good idea to always keep resumes on file in case staff

need to be hired quickly.

Summary

In this section we discussed some of the operational issues that you will need to

consider when developing community inclusion services. In the next section we

describe procedures for program evaluation.


SECTION 9: PROGRAM EVALUATION

Introduction

In this section we describe procedures for program evaluation. We begin with a

discussion of what should be evaluated, then provide a description of how to evaluate

each area and a process that can be used to design program evaluation activities in your

agency.

General Description

Program evaluation is critical for continual improvement of your program. In order to

develop and maintain a high quality program that meets the needs of adults with ASD

and that strives to increase the inclusion of its consumers in community settings, you

will need to gather and evaluate a number of different types of information on an

ongoing basis. In this section we describe an evaluation process adapted from

Grigal, Neubert, and Moon (2005) in the book “Transition Services for Students with

Significant Disabilities in College and Community Settings.”

Evaluation data will need to be collected from all stakeholders so that you are able to

make ongoing improvements and address issues in a timely manner. In general, to

evaluate the success of your program you will need to assess a) whether current

services are meeting the needs of the consumers, b) whether the services you are

providing are improving outcomes for all consumers, and c) whether all stakeholders

(consumers, families, employers, community members, supports coordinators, and so

on) are satisfied with your services. You may also want to assess the efficiency of your

program, for example whether you have the most efficient use of staff or money.

In addition to gathering information for program improvement, data will also need to

be collected for accountability purposes. Accountability requirements vary by funding

source, and you should check with supports coordinators to determine what

information they need to see. If you are part of a larger organization, you may also have

requirements on the collection and reporting of program data. In general, information

gathered for accountability purposes will need to assess a) whether consumers are

meeting their goals, and b) whether consumers are receiving the services they need. If

you are providing services through a number of funding sources that may have

different accountability requirements, we recommend that you determine the most

stringent accountability requirements and follow these for all consumers in your


program. Remember that it is always better to have too much information than too

little.

Program evaluation activities should be conducted to assess a number of factors. As

there is considerable overlap in the information you will need for program

improvement and for accountability purposes, we will discuss these two areas together

throughout this section. We recommend evaluating the following:

Consumer and staff activities: For consumers, this includes examining what

consumers are doing during their time with your program and whether this

aligns with their goals and interests. For staff, this will involve examining how

much time staff spend doing activities such as direct care, administrative work,

training, participating in meetings, and so on, and whether this aligns with their

qualifications and job responsibilities. You may even choose to evaluate the types

and quality of interactions when staff are involved in direct care. For example,

what percentage of time are staff engaged in activities related to consumers’

goals?

Consumer goal achievement: For each consumer, you will need to track

progress toward goals. This data can then be compiled across all consumers to

identify whether the program is providing effective instruction overall for

assisting consumers in reaching their goals.

Consumer, family, support staff, and employer/community member

satisfaction: Across all stakeholders, you should assess satisfaction with the

program.

Consumer retention: This involves tracking the number of consumers retained

in the program from year to year, and documenting reasons for leaving the

program. This can help inform future admissions decisions.

Staff retention: Similarly, this will involve tracking the number of staff retained

in the program from year to year, and documenting reasons for leaving. This can

help inform future hiring decisions.

Quality of life indicators: Beyond just goal attainment, it is important to assess

the quality of life of consumers in your program to determine effectiveness.

Program quality: This will involve continual assessment of whether the program

is adhering to the guiding principles outlined in section 1.

In the following section, we describe how conduct evaluation in each of these areas and

how to develop an effective evaluation process.

How to Implement


First, we describe how to evaluate each component. Below are some suggestions for

what should be evaluated.

Consumer and staff activities

Assessing consumer activities will provide you with some basic information on what

individuals are doing in your program. This information can be helpful for providing

feedback on consumer achievements to stakeholders and for keeping track of the

activities in which your program provides support. You will need to gather information

for each individual consumer, and then compile this information across all consumers

in your program. The information gathered should be compared to both individual

plans, to determine whether consumer are engaging in activities that match their goals,

interests, strengths, and preferences, and to your overall program vision, to determine

whether the activities in which you are actually providing support match what you

have envisioned for the program.

Information that should be gathered on consumer activities can include:

Total number of consumers served

Number of consumers receiving each type of service and proportion of time

For consumers in supported employment (including job finding)

o Employment sites in which consumers are working

o Number of consumers in full time/part time employment

o Average hourly pay

For consumers in job preparation services

o Job sampling locations which consumers have visited

o Number of consumers in job sampling sites

For consumers in community inclusion

o Community settings accessed by consumers

o Number of consumers regularly participating in each type of activity

(recreational activities, postsecondary education, volunteer work, etc.)

Assessing staff activities can provide information on what staff persons are actually

required to do in order to support consumers. Although this information may not be

particularly useful for accountability purposes, it serves a useful purpose internally for

program improvement. This information can be used to ensure that staff activities

match their responsibilities and qualifications, and can help identify when additional

staff or reassignment of staff is necessary. However, if the time that can be devoted to

program evaluation is limited, this is one area that could be considered to be

nonessential.


Information that should be gathered on staff activities can include:

For support staff in employment services, percentage of time spent on:

o Job support

o Seeking employment

o Transportation

o Data collection

o Planning

o Administrative duties

For support staff in community inclusion services, percentage of time spent on:

o Direct support in community settings

o Transportation

o Data collection

o Planning


For program coordinator(s), percentage of time spent on:

o Direct support

o Transportation

o Data collection

o Planning


o Networking/seeking opportunities for consumers

Consumer goal achievement

Determining whether consumers are making progress toward their goals is a critical

aspect of both program improvement and accountability. From an accountability

perspective, you should always be able to produce evidence that an individual

consumer has received instruction and opportunities to meet his or her goals and that

progress is occurring. For program improvement, you will want to compile data on

individual goal progress to determine whether the instructional approach and

opportunities that you are providing are effective for all consumers in your program.

The following will assist you to determine if consumers are meeting their goals:

For each consumer, document:

o Date of evaluation

o Number of goals for which your program is providing services

o Number of goals met/not met

o Reasons for unmet goals


o Responses to unmet goals

Across all consumers, total number of goals met and not met

Consumer, family, support staff, and employer/community member satisfaction

In order to continually improve your program, you will need to assess whether all

stakeholders are satisfied with the services you are providing. This information will

enable you to address concerns in a timely manner. Satisfaction can be assessed through

questionnaires, interviews, or phone interviews provided to each stakeholder. The

following is a list of areas in which you may want to assess satisfaction for each

stakeholder:

Consumer and family satisfaction with:

o Overall program

o Jobs/activities/settings

o Goals

o Progress made toward goals

o Transportation

o Hours

o Support provided by staff

o Level of community inclusion

Support staff satisfaction with:

o Support received from supervisors

o Progress made toward goals

o Current placement

o Opportunities available to current consumer

Employer satisfaction with:

o Attendance

o Punctuality

o Work performance

o Attitude

o Appearance

o Dependability

o Adaptability

o Cooperation and interpersonal skills

o Performance of support staff

o Overall satisfaction with consumer and program

Consumer retention


By assessing consumer retention, you will be able to examine whether there are issues

with your program or your choice of consumers that causes consumers to leave the

program. This information will enable you to address any problems with your program

and will inform future admissions decisions. Evaluation activities in this area will

include tracking the number of consumers retained across evaluation periods and the

reasons for any consumers leaving.

Staff retention

By assessing staff retention, you will also be able to examine whether there are issues

with for example, the level of support that staff are receiving or the responsibilities of

the job. This information will allow you to address problems with your program and

will inform future hiring decisions. Evaluation activities in this area will include

tracking the number of staff retained across evaluation periods and the reasons for any

staff leaving. Exit interviews may also provide useful information for program

evaluation.

Quality of Life Indicators

Assessing the quality of life of consumers in your program will allow you to go beyond

just goal achievement and activities to determine whether your program is having a

meaningful effect on the lives of your consumers. This can help to strengthen the

information that you need for accountability purposes and can help you identify if you

need to address problems with individual programs. Perhaps most importantly,

though, this information can provide convincing evidence to stakeholders and to people

who may be interested in learning from or replicating your program that your approach

is effective for improving meaningful outcomes for adults with ASD.

The following methods will help you to demonstrate quality of life outcomes:

Family and Individual Quality of Life questionnaires

Measures of familial and/or consumer stress

Data on consumer employment satisfaction

Data on individual number of social contacts and satisfaction with these social

contacts

Data on overall community integration for each consumer (including

employment and non-work related activities)

Program Quality


Throughout this manual, we have provided checklists that link the guidance on

providing services back to the principles on which we based our approach. These

checklists can be used as an assessment tool for you to determine whether all aspects of

your program adhere to the guiding principles.

Process for designing and conducting program evaluation

Next, we will describe the process for designing and conducting program evaluation.

Step 1: Decide what information you will gather

In the above section we provided many ideas for program evaluation activities. As a

program you will need to decide which information is important to you. You will need

to find a balance between collecting enough information to be able to continually

improve your program and what you are reasonable able to collect given the resources

and time that you have. For this reason, we recommend that you begin by determining

which evaluation activities are essential and practical for you to complete.

Step 2: Decide how you will collect and compile information

COLLECT, REVIEW, AND SHARE

Collect and compile evaluation data, review to determine if changes are needed, and share

WHO

Decide who is responsible for collecting and compiling information

WHEN

Decide when and how often you will collect and review this information

HOW

Decide how you will collect and compile information

WHAT

Decide what information you will gather


Once you know what information you want to gather, you will need to decide how to

go about collecting this information. In the appendix we have provided forms for

several of the evaluation activities. You may want to use these forms or develop your

own forms. You will need to have several types of forms ready: forms for collecting

individual data on a daily basis, forms for compiling individual data, and forms for

conducting periodic assessments such as satisfaction surveys. You may be able to use

forms that are already being completed as part of each consumer’s program for

program evaluation purposes (e.g., instructional data sheets, daily schedules, staff or

consumer timesheets), and this may be preferable to requiring staff to fill out additional

forms. You should also consider how you are going to compile program evaluation data

in a way that provides the information necessary for review. Make sure that you have a

plan for how you will collect and compile information for all of the evaluation activities

that you have decided are important.

Step 3: Decide when and how often you will collect and review this information

The next step is to determine how often you plan to review program evaluation data.

This will differ for each evaluation area: for example, you may want to assess goal

achievement quarterly but employer satisfaction annually. Again, you will need to find

a balance between how often you would like to review the information you have

gathered and when you can make time to do this. Once you know how often you will

review the information, this will help you decide how often to collect information. Some

evaluation activities, for example assessing instructional data or consumer activities,

will occur daily, whereas others, for example evaluating employer satisfaction, will only

need to occur at the review date.

Step 4: Decide who is responsible for collecting and compiling information

Next, you will need to assign responsibilities for collecting and compiling information.

For evaluation activities that occur daily, staff may be responsible for collecting

necessary information. For evaluation activities that occur only periodically, such as

sending out questionnaires or using quality of life measures, you should assign

responsibility to one person in your program. You must also decide who will be

responsible for compiling the information gathered for program evaluation. This person

may want to develop procedures for all staff for gathering and turning in the

documentation that will be necessary for program evaluation.

Step 5: Collect, review, and share


Once the procedures for program evaluation are in place, you can begin collecting and

compiling the information you have selected. You should review this information

periodically based on your planned procedures, and determine when changes are

needed to the overall program or individual programs. It is important to share the

results of your program evaluation activities with stakeholders (e.g., consumers and

families, support staff, administrators). You should also evaluate your program

evaluation process periodically to determine if you are gathering all the information

you need and if the procedures you have developed are effective.

Forms (see Appendix: Forms)

A number of forms for program evaluation can be found in the appendix:

Consumer activities: form adapted from Grigal, Neubert, and Moon (2005)

Goal achievement: Form adapted from Grigal, Neubert, and Moon (2005)

CAAPP Family satisfaction

CAAPP Employer satisfaction

CAAPP Consumer questionnaire

Resources

A number of published tools can help with program evaluation. Two measures of

quality of life that are used by the CAAPP at Devereux CARES are:

Abidin, R. R. (1995). Parenting Stress Index (3rd Edition).

Available for purchase from PAR: www.parinc.com

Schalock, R. L., & Keith, K. D. (1993). Quality of Life Questionnaire (QOL-Q).

Available for purchase from IDS Publishing: www.idspublishing.com

Summary

In this section we described how to conduct program evaluation. This is the final

section of the manual. In the appendices, you will find:

A. Information on funding sources

B. A collection of forms that can be used for community inclusion services, and

http://www.parinc.com/

http://www.idspublishing.com/


C. Checklists for ensuring that each service you are providing adheres to the

guiding principles for this manual.


References

Association for Persons in Supported Employment (1998). Ethical guidelines for

professionals in supported employment. Retrieved from:


Bambara, L. M., & Kern, L. (2005). Individualized supports for students with problem

behaviors: Designing positive behavior support plans. New York, NY: Guilford Press.

Bambara, L. M., & Knoster, T. P. (2009). Designing positive behavior support plans.

Washington, DC: American Association on Intellectual and Developmental Disabilities.

Browder, D. M. (2001). Curriculum and assessment for students with moderate and severe

disabilities. New York, NY: Guilford Press.

Gray, C.A. (2000). The new Social Story book. Arlington, TX: Future Horizons.

Gray, C. (2004). Social Stories 10.0: The new defining criteria. Jenison Autism Journal, 15,

1-21.

Grigal, M., Neubert, D. A., & Moon, M. S. (2005). Transition services for students with

significant disabilities in college and community settings. Austin, TX: Pro-Ed.

Krantz, P. J., & McClannahan, L. E. (1998). Social interaction skills for children with

autism: A script-fading procedure for beginning readers. Journal of Applied Behavior

Analysis, 31, 191–202.

Krantz, P. J., & McClannahan, L. E. (1993). Teaching children with autism to initiate to

peers: Effects of a script-fading procedure. Journal of Applied Behavior Analysis, 26, 121–

132.

Martin, J. E., Mithaug, D. E., Oliphint, J. H., Husch, J.V., & Frazier, E. S. (2002). Self-

directed employment: A handbook for transition teachers and employment specialists.

Baltimore, MD: Paul H. Brookes.

McClannahan, L. E., & Krantz, P. J. (2005). Teaching conversation to children with

autism: Scripts and script fading. Bethesda, MD: Woodbine House.



McClannahan, L. E., & Krantz, P. (2010). Activity schedules for children with autism:

Teaching independent behavior. Bethesda, MD: Woodbine House.

Mount, B. (2000). Life building: Opening windows for change using personal future planning.

New York, NY: Graphic Futures, Inc.

Trach, J. S., & Shelden, D. L. (1999). Natural supports: A foundation for employment.

Washington, DC: American Association on Intellectual and Developmental Disabilities.

Sitlington, P. L., Neubert, D. A., Begun, W. H., Lombard, R., & Leconte, P. (2007). Assess

for success: A practitioner’s handbook on transition assessment. Thousand Oaks, CA: Corwin

Press.

Wehman, P., Inge, K. J., W. G., Revell, & Brook, V. A. (Eds.) (2007) . Real work for real pay:

Inclusive employment for people with disabilities. Baltimore, MD: Paul H. Brookes.

Wehman, P., Smith, M. D., & Schall, C. (2009). Autism and the transition to adulthood:

Success beyond the classroom. Baltimore, MD: Paul H. Brookes.

Wilde, L. D., Koegel, L. K., & Koegel, R. L. (1992). Increasing success in school through

priming: A training manual. Santa Barbara: University of California.


APPENDIX A: FUNDING SOURCES


COMPARISON OF FUNDING SOURCES

Funding source Adult Autism Waiver

Administered by Bureau of Autism Services

Type of program 1915(c) Medicaid Home and Community-Based Services Waiver

Eligibility – diagnosis Autism Spectrum Disorder

Eligibility – level of care Either Intermediate Care Facility for people with Other Related Conditions

(ICF/ORC) or Intermediate Care Facility for people with Mental

Retardation (ICF/MR), IQ score is not considered.

Eligibility – financial Medical Assistance Financial Eligibility requirements for long-term care

participants

Eligibility – age 21 and older

Geographic area Statewide

To enroll as a provider

Requirements for enrollment as an Adult Autism Waiver provider include:

1. Be enrolled in PROMISe as a Medical Assistance provider

2. Complete an Autism Waiver provider application

3. Complete an Autism Waiver Supplemental Agreement

4. Submit copies of applicable licenses/credentials to the Bureau of Autism Services

5. Meet training requirements for the service(s) you intend to provide

6. At least one staff person must complete the SPeCTRUM training.

Contact the Bureau of Autism Services at 1-866-539-7689, and press 1 for English, press 1 again for the

Autism Waiver, and then press 4 for the provider voice mailbox. Leave a message with your name,

agency, phone number and email address and you will receive an electronic "Provider Packet" which

includes necessary links, information and instructions on how to become an enrolled provider.

Provider qualifications: Employment services

Supported Employment Agencies are the only agencies able to provide Supported Employment services

as long as they have signed a Medical Assistance Provider Agreement. The staff must be at least 18 years

or older, have a high school diploma or equivalent, and must complete all required trainings developed

by the Bureau of Autism Services regarding people with autism spectrum disorders and have completed

required vocational training developed by the Bureau of Autism Services. The Supported Employment

Agency must have automobile insurance for all automobiles owned, leased, and /or hired used as a

component of this service. The Bureau of Autism Services is responsible for verification of qualifications

and will do so on a bi-annual basis.

Provider qualifications: Community integration services

Community Inclusion services will be provided through a Community Inclusion agency that has signed a

Medical Assistance Provider Agreement. The Community Inclusion staff must be 18 or older, have a high

school diploma or equivalent and completed all required training developed by the Bureau of Autism

Services for people with autism spectrum disorder. The Community Inclusion Agency must have

automobile insurance for all automobiles owned, leased, and/or hired used as a component of this

service. The Bureau of Autism Services is responsible for verification of qualifications and will do so on a

bi-annual basis.


Funding source ACAP

Administered by Bureau of Autism Services

Type of program Prepaid Inpatient Health Plan: The ACAP provider and their

network of providers provide medical, dental, behavioral

health and home and community-based services,

Eligibility – diagnosis Autism Spectrum Disorder

Eligibility – level of

care

Either Intermediate Care Facility for people with Other Related

Conditions (ICF/ORC) or Intermediate Care Facility for people

with Mental Retardation (ICF/MR), IQ score is not considered.

Eligibility – financial Medical Assistance Financial Eligibility as determined by the

County Assistance Office (CAO) (Long Term Care

requirements do not apply)


Geographic area Cumberland, Dauphin, Lancaster, and Chester Counties


Not applicable – only one designated provider at this time


Not applicable at this time


Not applicable at this time


Funding source Consolidated and P/FDS Waivers

Administered by Office of Developmental Programs

Type of program 1915(c) Medicaid Home and Community-Based Services

Waivers

Eligibility – diagnosis Intellectual disability (also known as mental retardation)


care

Intermediate Care Facility for people with Mental Retardation

(ICF/MR)

Eligibility – financial Medical Assistance Financial Eligibility requirements for long-

term care participants




1. Meet business requirements (e.g., tax laws, licensing, any fire and safety standards,

and Fair Labor practices)

2. Register with the Home and Community Services Information System (HCSIS).

3. If the services require licensure, apply for and receive licensure.

4. Become a Qualified Provider. Review the qualifications related to the services you

want to provide in the applicable waiver.

5. Enroll each service location in PROMISe, the Department’s payment system.

6. Participate in the Individual Support Plan (ISP) team meetings for the individuals

you serve.

Ongoing, participate in annual qualification (including licensing if required), training

programs required by ODP, any ODP required information reporting (such as cost

reports), and any other requirements in the ODP MA Provider Agreement


Funding source OBRA Waiver

Administered by Bureau of Home and Community Based Services (BHCBS).

Type of program 1915(c) Medicaid Home and Community-Based Services

Waivers

Eligibility – diagnosis Developmental disability (but not with mental retardation or

have a major mental disorder as a primary diagnosis),

manifested before age 22, likely to continue indefinitely, and

results in three or more substantial functional limitations in

major life activity


care

Intermediate Care Facility for people with Other Related

Conditions (ICF/ORC)

Eligibility – financial Financial eligibility requirements to receive waiver services

determined by County Assistance Office (CAO)

Eligibility – age 18 and older (new applicants over 60 will be referred to

Department of Aging waiver)



Meet enrolled provider participation requirements as described in Section 1101 Medical

Assistance provider participation requirement.

Agency employees must complete CORE training requirements.


Supported Employment Agency must employ individuals who meet the following

standards:

• Supported employment workers must be at least 18 years of age, and

• Have a high school diploma or equivalent

• Have six months of paid or volunteer experience working with people with

disabilities

• Complete CORE, service and annual training requirements.


The agency must employ individuals who meet the following standards:

• Be at least age 18 or older

• Have a high school diploma or equivalent

• Have six months of paid or volunteer experience working with people with

disabilities

• Complete CORE, service and annual training requirements.


APPENDIX B: CHECKLISTS


Checklist for Preparing for Employment

Guiding principle Key indicators Y/N

1. Driven and guided by

the individual and

his/her family

Services and placement decisions are based on

the individual’s interests, preferences, needs,

and goals.

2. Promote self-

determination and

self-advocacy

Opportunities to express self-determination are

provided each day

Supports are provided for individuals to self-

advocate

3. Individualized Services for all individuals match their unique

interests, preferences, needs, and goals.

4. Provided to

participate in every

aspect of socio-

cultural life


sought that allow individuals to feel productive

5. Based on a

philosophy of

acceptance






appropriate

Supports for preparing for employment are

provided in a nonintrusive and respectful

manner (e.g., disclosing disability only when

necessary, allowing the individual to speak for

his/herself)

7. Promote the full

inclusion of

individuals in their

communities


sought in inclusive settings

8. Promote

independence and

foster

interdependence on

naturally occurring

supports in the

Transitional work services allow the individual

to be as independent as possible (e.g., learning

to work independently)

Whenever possible, natural supports are found

in community settings


individual’s

environments

9. Culturally responsive Experiences are sought that fit within the


10. Provided with

integrity and quality

Observations are conducted periodically to

ensure the quality of these services


Checklist for Finding Employment



the individual and

his/her family

Throughout the job seeking process, the

individual’s interests and preferences are

considered above all other factors.

2. Promote self-

determination and

self-advocacy

Job seeking process allows the individual to

make choices regarding potential jobs, places to

apply to, and ultimately to decide which job to

choose.

Instruction in interview skills includes

instruction in self-advocacy

3. Individualized

Appropriate job matches are made based on

assessment of the individual and analysis of the

work site

4. Provided to


aspect of socio-

cultural life

Employment is sought in inclusive settings

5. Based on a philosophy

of acceptance






appropriate

Supports for finding employment are provided

in a nonintrusive and respectful manner (e.g.,

not disclosing disability, allowing the individual

to speak for his/herself)

7. Promote the full

inclusion of


communities

Employment is sought in inclusive settings and

in the individual’s community

8. Promote

independence and

foster

interdependence on

naturally occurring

supports in the

Job seeking services allow the individual to be

as independent as possible (e.g., inquiring about

available positions, completing applications,

interviewing)

Whenever possible, typical job finding services


individual’s

environments

are accessed by the individual

9. Culturally responsive Employment is sought that fits within the


10. Provided with


Observations are conducted periodically to

ensure the quality of these services


Checklist for Supported Employment



the individual and

his/her family

Assessment includes consideration of the

supports desired by the individual.

Supports are provided in a manner consistent

with the desires of the individual.

Natural supports match the preferences of the

individual.

2. Promote self-

determination and

self-advocacy

Includes supports to allow the individual to

self-advocate in the work setting (e.g., disclose

disability, request accommodations, request

changes to certain aspects of the job)

3. Individualized Assessment is conducted for each individual in

the work setting.

Supports are planned on an individual basis

4. Provided to


aspect of socio-

cultural life

Assessment includes consideration of all

aspects of the work environment including

social


of acceptance






appropriate

Supports are provided in a nonintrusive

manner and are respectful of the individual

(e.g., not disclosing disability, speaking

positively about the individual to coworkers)

7. Promote the full

inclusion of

Supports provided to allow the individual to be

fully included in the work setting.



communities

When supports are needed, natural supports

are developed in the work setting

8. Promote

independence and

foster

interdependence on

naturally occurring

supports in the

individual’s

environments

Supports include instruction to perform at the

maximum level of independence.

Naturally occurring supports are built in order

to fade paid supports as much as possible

9. Culturally responsive Assessment takes into account the individual’s

culture and the culture of the workplace

Supports are provided in a manner that is

consistent with and respectful of the

individual’s culture

10. Provided with


Periodic observations of supports provision

Feedback from supervisors in the work setting

to assess satisfaction with employee and

supports provider


Checklist for Community Inclusion



the individual and

his/her family

The individual decides in which settings and

activities he or she wants support

2. Promote self-

determination and

self-advocacy

Whenever appropriate, the individual is

encouraged to self-advocate for his or her needs

and rights in community settings

3. Individualized Community inclusion services are based on an

individual assessment of the interests,

preferences, and strengths of the individual

4. Provided to


aspect of socio-

cultural life


activities in which supports may be needed, all

aspects of community life are considered


of acceptance






appropriate

Supports are provided in a manner which treats

the individual with dignity


activities in which supports may be needed,

activities in which persons of the same age

typically participate are considered

7. Promote the full

inclusion of


communities

Supports are provided to allow the individual to

interact with typical persons in each setting

8. Promote

independence and

foster

interdependence on

naturally occurring

supports in the

individual’s

Critical skills are targeted for instruction. When

further supports are needed, naturally occurring

supports are considered first


environments

9. Culturally responsive Cultural activities are included when conducting

an inventory of settings and activities in which

supports may be needed.

Supports take into consideration the culture of the

individual

10. Provided with


Periodic observations are conducted of supports

provision.

Feedback is provided by supervisors.


APPENDIX C: FORMS

Devereux CARES future planning form for annual meetings

Blank weekly schedule

Blank job analysis

Blank sample job profile

Situational assessment form

Task analysis

Activity matrix

Consumer activities compilation form

Consumer goal achievement compilation form

CAAPP satisfaction questionnaires:

Family

Employer

Consumer

Devereux CARES application form


Devereux CARES CAAPP

Future Planning Form for Annual Meeting

Name:

Date of Meetings:

Attendees:

Current Status:

Areas of Improvement:

Areas of Skill Expansion:

Goals for Coming Year:

Goals for Five Years:

Immediate Actions Steps:


Blank Weekly Schedule

Consumer: ___________________________________________

Provider: __________________________________________

Support team: _________________________________________

Week of:

Time Monday Tuesday Wednesday Thursday Friday


Job Analysis Form

Note: This job analysis format is based on the job analysis form by Sitlington, Neubert,

Begun, Lombarde, and Leconte (2007)

Job title:

Job location:

Address:

Phone:

Nature of business:

Number employed:

Person interviewed:

Date:

A. BASIC QUALIFICATIONS

1. Age

2. Experience

3. Tests

4. Application

5. Health

requirements

6. Physical

requirements

Demands Much Little None

Lift

Carry

Push

Pull

Walk

Climb

Stoop

Kneel

Crouch

Comments:

7. Educational


requirements

8. Essential skills Skill Much Little None

Travel

Telephone

Customer

relations

Supervisor

relations

Employee

relations

Comments:

B. WORKING CONDITIONS

Wages

Hours

Days

Length

Benefits

Work environment

C. WORK PERFORMED


Blank Job Profile

Name:

Date of birth:

Address:

Education:

Work experiences:

Life activities and experiences:

Strengths:

Work preferences and goals:

Learning characteristics and accommodations needed:

Potential resources or connections:


Situational Assessment Form

Location:

Name:

Dates of assessment:

Activities in this location:

Complete the first column before starting the situational assessments. Visit the setting and

observe typical persons participating in the activities. Use each additional column to record the

level of prompting or support required in each situational assessment.

Key for level of prompting or support required in each assessment: I = independent, G =

gesture, IV = indirect verbal, DV = direct verbal, M = model, PP = partial physical, P = full

physical, IC = instructor completed

Person’s responses in each assessment

Date: Date: Date: Date:

Skills/tasks that people engage in

Routines that people follow

Other behaviors that people exhibit (consider dress, communication, social interaction, voice

level, etc.)


Variables that may affect success in

this setting (consider physical space,

noise, odors, social climate,

interactions with others, physical

demands, pace, etc.):

Supports that are typically available

to all persons in this setting:

Person’s interest in this setting and

activities:

Skills/routines/behaviors performed

independently:

Skills/routines/behaviors that

required prompting:

Other supports needed:


Task Analysis Data Sheet

Skill:

Mastery:

Task Analysis Cue Date

%

Independent/Correct

Coding System


Activity Matrix

Name: ___________________________ Date: ________________________

Activity Goal #1 Goal #2 Goal #3


Compilation of Consumer Activities

Date:

Fill in the blank for each of the following:

Total number of consumer served

Number of consumers working full time

Average rate of pay (FT)

Number of consumers working part time

Average rate of pay (PT)

Number of consumers job shadowing

Number of consumers volunteering

Number of consumers attending postsecondary or continuing education

Number of consumers receiving community inclusion services

List job sites consumers are working

at:

List job sites consumers are job

shadowing or volunteering at:

List community locations which

consumers are accessing:

Other activities:

Recommendations for

changes/improvements:

Adapted from Grigal, Neubert & Moon (2005)


Compilation of Consumer Goal Achievement

Review date:

Consumer name Date # of goals

met

# of goals

unmet

Unmet goals and

reasons

Response to

unmet goals

Total number of goals met:

Total number of goals not met:

Adapted from Grigal, Neubert & Moon (2005)


CAAPP Family Satisfaction Survey

We are completing satisfaction surveys from family members and consumers to as a way to improve our program. We would greatly appreciate you taking the time to complete the following questionnaire and returning it to us by ______________________________. If you would prefer to remain anonymous, please enclose this form in an envelope. Thanks for your help! Please circle the number that corresponds to the most appropriate response for the following statements. If you do not feel like a statement is appropriate to your situation, does not apply or you do not have enough information to judge, please leave it blank.

1. I feel that CAAPP is providing my child with appropriate services.

1 2 3 4 5 Strongly Disagree Unsure Strongly Agree

2. I am satisfied with my child’s progress.


3. I feel that CAAPP does an outstanding job assessing my child on individual basis through in-person

observation. 1 2 3 4 5

Strongly Disagree Unsure Strongly Agree

4. I feel that CAAPP does an outstanding job assessing my child’s preferences. 1 2 3 4 5


5. I feel that CAAPP does an outstanding job communicating with me through in-person visits, phone calls, and/or emails when necessary.


6. I feel that the CAAPP staff treat my child in a warm and respectful manner.


7. I am pleased with the community-based and vocational services program.


8. I feel that CAAPP is increasing my child’s independence in community skills.


9. I feel that CAAPP is increasing my child’s independence in completion of tasks of daily living


10. I feel that CAAPP is increasing my child’s independence in developing vocational skills.

Community Inclusion Manual 156 1 2 3 4 5


11. I feel that CAAPP is increasing my child’s functional communicational and social skills. 1 2 3 4 5


12. I feel like an equal member of my child’s intervention team. 1 2 3 4 5

Strongly Disagree Unsure Strongly Agree 13. CAAPP staff make themselves available to discuss ideas and/or concerns.


14. I am made aware of schedules and meetings.


15. I am pleased that my child is part of CAAPP.


16. I would recommend CAAPP services to others.


17. I feel that staff have access to appropriate materials and equipment.


18. I feel that there are ample opportunities for parental involvement.


The following are the strengths of the CAAPP program: The following are areas where improvement is needed:

Community Inclusion Manual 157 CAAPP Employer Satisfaction

1. I have been working with CAAPP for:

< 1 month 2-5 months 6-11 months

2. Information (vocal or written) about Autism Spectrum Disorders was/is available to me through

CAAPP to help me assist my employee.

1 – Strongly Disagree 2 – Disagree 3 – Neutral 4 – Agree 5 – Strongly Agree N/A

3. I am/was satisfied with information, support, and/or materials provided to me through CAAPP for

employment assistance or training for my employee.


4. After the initial training/employment period, I feel that CAAPP has provided additional support or

assistance as necessary or requested.


5. If I needed more support, I would feel comfortable requesting it from CAAPP and I would know who

to contact.


6. I would work with CAAPP in the future if I had the need for another employee.


Strengths of CAAPP:

Areas of Improvement for CAAPP:

Other comments for CAAPP:

Community Inclusion Manual 158 CAAPP Consumer Satisfaction Survey

We are completing satisfaction surveys from family members and consumers to as a way to improve our program. We would greatly appreciate you taking the time to complete the following questionnaire and returning it to us by ____________________. If you would prefer to remain anonymous, please enclose this form in an envelope. Thanks for your help! Please circle the number that corresponds to the most appropriate response for the following statements. If you do not feel like a statement is appropriate to your situation, please leave it blank.

1. I feel that CAAPP is providing me with great services.


19. I am satisfied with my progress.


20. I feel that CAAPP does an outstanding job knowing what I need by watching me.


21. I feel that CAAPP does an outstanding job knowing what I prefer.


22. I feel that CAAPP does an outstanding job talking to me on the phone and in person.


23. I feel that the CAAPP staff treat me in a warm and respectful manner.


24. I am pleased with the community and work programs.


25. I feel that CAAPP is increasing my independence in community skills.


26. I feel that CAAPP is increasing my independence in completion of tasks of daily living.


27. I feel that CAAPP is increasing my independence in developing work skills.


28. I feel that CAAPP is increasing my social skills.

Community Inclusion Manual 159 1 2 3 4 5


29. I feel like an equal member of my CAAPP team. 1 2 3 4 5

Strongly Disagree Unsure Strongly Agree 30. CAAPP staff make themselves available to discuss ideas and/or concerns.


31. I am made aware of schedules and meetings.


32. I am pleased that I am part of CAAPP.


33. I would recommend CAAPP services to others.


The following are the strengths of the CAAPP program: The following are areas where improvement is needed:

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